Durability of mitral valve repair for degenerative mitral valve disease in patients with obstructive hypertrophic cardiomyopathy.

Abstract

In patients with obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation, some advocate valve replacement because it addresses both valve disease and outflow tract obstruction. To avoid late prosthesis-related complications, we have favored septal myectomy and concomitant mitral valve repair, and the present study assesses the outcomes of this approach. Among 3029 patients with obstructive hypertrophic cardiomyopathy undergoing septal myectomy, 120 received concomitant mitral valve repair for leaflet prolapse. Patients were matched by propensity score to those undergoing mitral valve repair for isolated degenerative mitral regurgitation. Patients' median age was 63.7 years, and 35.6% were female. Preoperatively, patients with obstructive hypertrophic cardiomyopathy were less likely to have grade 2+ or greater mitral regurgitation (87.6% vs 100%, P < .001). Patients with obstructive hypertrophic cardiomyopathy more often required leaflet plication or Alfieri sutures, whereas those with isolated degenerative mitral regurgitation were more likely to undergo leaflet resections and artificial neochordae placement. Mitral annuloplasty was performed less frequently in patients with obstructive hypertrophic cardiomyopathy (60.0% vs 99.2%, P < .001). Early morbidity and mortality were comparable, with 1 (0.8%) death in each group. There were no significant differences in late survival (10 years, 79% for obstructive hypertrophic cardiomyopathy vs 82% for isolated degenerative mitral regurgitation, P = .85). Recurrence of severe mitral regurgitation at 10 years was similar between groups (10.2% for obstructive hypertrophic cardiomyopathy vs 6.5% isolated degenerative mitral regurgitation, P = .61), as was the rate of mitral valve reoperation (5.5% vs 2.7%, P = .79). Mitral valve repair for concomitant degenerative mitral regurgitation in patients with obstructive hypertrophic cardiomyopathy is feasible, safe, and durable, with similar survival and reoperation rates to those of patients with isolated degenerative mitral regurgitation.