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Ann Thorac Surg 2005;80:217-223
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Beyond Extended Myectomy for Hypertrophic Cardiomyopathy: The Resection-Plication-Release (RPR) Repair

^a Division of Cardiothoracic Surgery, St. Luke’s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York
^b Hypertrophic Cardiomyopathy Program, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York
^c Department of Anesthesia, St. Luke’s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York

Accepted for publication January 10, 2005.

^_* Address reprint requests to Dr Swistel, Cardiothoracic Surgery, St. Luke’s-Roosevelt Medical Center, Columbia University, College of Physicians and Surgeons, 1111 Amsterdam Ave, New York, NY10025 (Email: sbalaram{at}chpnet.org).

BACKGROUND: Extended myectomy for left ventricular outflow tract obstruction (LVOTO) due to hypertrophic cardiomyopathy (HCM) has good long-term results. In addition to the midseptal resection (R) for HCM, our group has introduced a novel variation in anterior leaflet plication (P) and release (R) of papillary muscle attachments. We sought to investigate the medium-term success of this three-step repair that addresses all aspects of complex HCM pathology.

METHODS: Nineteen patients underwent resection-plication-release repair for complex HCM pathology. Transesophageal echocardiography was performed on all patients preoperatively and postoperatively to assess adequacy of resection, left ventricular outflow tract gradients, and mitral valve function. All patients underwent transthoracic outpatient echocardiography at a mean follow-up of 2.4 ± 2.1 years (range, 0.5 to 6).

RESULTS: The average age of the patients was 57 ± 14 years. The preoperative peak LVOTO was 137 ± 45 mm Hg. The average degree of mitral regurgitation was 3.1. The average length of stay was 7.5 ± 3.3 days. There were no readmissions or deaths in the group. Initial postoperative transesophageal echocardiography demonstrated marked reduction in LVOTO to 10 ± 17 mm Hg (p < 0.0001) and significant improvement in mitral regurgitation to 0.2 (p < 0.0001). In follow-up, the LVOT gradient remained low at 6 ± 14 (p > 0.0001) and mitral regurgitation remained insignificant at 0.4 (p < 0.0001).

CONCLUSIONS: Anterior leaflet plication and papillary muscle release are logical adjuncts to septal resection in the treatment of the complicated pathophysiology of obstructive HCM. Durable long-term results can be achieved with an aggressive approach to mitral valve pathology in conjunction with extended myectomy.