«Edge-to-edge» mitral valve repair for septal myectomy versus isolated myectomy: a pilot randomized trial

Abstract

Background . Septal myectomy is currently the «gold» standard of surgical treatment of patients with obstructive hypertrophic cardiomyopathy. In some cases, isolated septal myectomy does not eliminate SAM-induced mitral insufficiency. Cardiac surgeons sometimes perform combined interventions on the mitral valve, such as «edge-to-edge» mitral valve repair. Aim . Evaluation of the safety and efficacy of combined edge-to-edge mitral valve repair in septal myectomy compared with isolated septal myectomy. Methods . Recruitment to the study was carried out for the period from 2019 to 2022 at the Meshalkin National Medical Research Center of the Ministry of Health of Russia. Twenty patients was performed combined «edge-to-edge» mitral valve repair with septal myectomy, 20 patients with isolated myectomy were included in the control group. The study assessed immediate and mid-term results after 12 months. Results . Combined edge-to-edge mitral valve repair demonstrates better intraoperative efficacy compared with isolated septal myectomy (95,0% versus 50,0%, p=0,001), but is accompanied by increased transmitral peak (6,8±2,1 vs 4,9±3,2 mmHg, p=0,03) and medium (3,4±1,4 vs 2,5±1,7 mmHg, p=0,05) gradients. Both techniques are associated with a low level of hospital mortality and complications in the early postoperative period, high survival after 12 months. Conclusion . Combined mitral valve repair using the «edge-to-edge» technique is comparable safe to isolated myectomy, but better eliminates SAM-induced mitral insufficiency. «Edge-to-edge» mitral valve repair is characterized by increased transmitral gradients.