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

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.

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