The Journal of Thoracic and Cardiovascular Surgery. 140(2):317–324, AUGUST 2010
PMID: 20038476
Issn Print: 0022-5223
Publication Date: August 2010
Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation
Deborah Kwon;Nicholas Smedira;Maran Thamilarasan;Bruce Lytle;Harry Lever;Milind Desai;
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aTomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OhiobDepartment of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Abstract
In patients with hypertrophic cardiomyopathy with bifid hypermobile papillary muscles and a dynamic left ventricular outflow tract gradient, we performed surgical papillary muscle reorientation, fixing the mobile papillary muscle to the posterior left ventricle to reduce mobility. We report the outcomes of patients with hypertrophic cardiomyopathy undergoing surgical papillary muscle reorientation versus those of patients undergoing standard surgical procedures.We studied 204 consecutive patients with hypertrophic cardiomyopathy undergoing surgical intervention (after consensus decision) for symptomatic left ventricular outflow tract gradient. Preoperative and postoperative maximal (resting/provocable) left ventricular outflow tract gradients were recorded by using echocardiographic analysis.The population was divided into 3 groups: (1) isolated myectomy (n = 143; age, 54 ± 14 years; 48% men), (2) myectomy plus mitral valve repair/replacement (n = 39; age, 54 ± 13 years; 54% men), and (3) papillary muscle reorientation with or without myectomy (n = 22; age, 50 ± 14 years; 59% men). The mean preoperative (103 ± 32, 103 ± 32, and 114 ± 36 mm Hg; P = .3) and predischarge (15 ± 18, 14 ± 14, and 16 ± 21 mm Hg; P = .9) maximal left ventricular outflow tract gradients were similar. There were no deaths either in the hospital or at 30 days. At a median follow-up of 166 days (interquartile range, 74–343 days), 21 of 22 patients in group 3 were asymptomatic. One patient in group 3 had a symptomatic left ventricular outflow tract gradient (87 mm Hg) requiring mitral valve replacement.In patients with hypertrophic cardiomyopathy with bifid hypermobile papillary muscles (even with a basal septal thickness <1.5 cm), papillary muscle reorientation reduces the symptomatic left ventricular outflow tract gradient. Long-term outcomes need to be ascertained.
