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Ann Thorac Surg 2008;86:1539-1545. doi:10.1016/j.athoracsur.2008.07.048
© 2008 The Society of Thoracic Surgeons
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Original Articles: Adult Cardiac

Resection-Plication-Release for Hypertrophic Cardiomyopathy: Clinical and Echocardiographic Follow-Up

Sandhya K. Balaram, MD, PhDa,*, Leslie Tyrie, MDb, Mark V. Sherrid, MDc, John Afthinos, MDb, Zak Hillel, MD, PhDd, Glenda Winson, RNc, Daniel G. Swistel, MDa

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

Accepted for publication July 16, 2008.

* Address correspondence to Dr Balaram, Division of Cardiothoracic Surgery, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY 10025 (Email: sbalaram{at}chpnet.org).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Abnormal positioning and size of the mitral valve contribute to the systolic anterior motion and mitral-septal contact that are important components of obstructive hypertrophic cardiomyopathy (HCM). The RPR repair (resection of the septum, plication of the anterior leaflet, and release of papillary muscle attachments) addresses all aspects of this complex pathology. This study reports outcomes regarding effectiveness of the RPR repair.

Methods: Fifty consecutive unselected patients (average age, 55.8 years) undergoing RPR repair for obstructive HCM from 1997 to 2007 were studied. Each patient underwent preoperative and postoperative transthoracic echocardiograms to document gradient, ejection fraction, degree of mitral regurgitation, and systolic anterior motion. Intraoperative transesophageal echocardiogram was used to guide all surgical repairs. Clinical follow-up included patient interviews to determine New York Heart Association (NYHA) status.

Results: Concomitant operations were performed in 25 patients (50%). Postoperative mortality was 0%. Average mean left ventricular outflow tract gradients decreased from 134 ± 40 to 2.8 ± 8.0. Mitral regurgitation improved from a mean of 2.5 to 0.1 (p < 0.001). Average length of stay was 6.9 ± 2.7 days. NYHA class improved from 3.0 ± 0.6 to 1.2 ± 0.5. Follow-up was 100%, with a mean of 2.5 ± 1.8 years. Average mitral regurgitation at follow-up was 0.9, with no residual systolic anterior motion.

Conclusions: The RPR repair is safe and effective for symptomatic obstructive HCM. Our data support repair of the mitral valve that results in good intermediate outcomes with respect to gradient, mitral regurgitation, and clinical status.




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