Surgical Treatment Of Hypertrophic Obstructive Cardiomyopathy With Mitral Valve Disease

Objective: A retrospective study was conducted to evaluate the surgical outcomes and long-term health-related quality of life in patients with hypertrophic obstructive cardiomyopathy(Hypertrophic obstructive cardiomyopathy,HOCM)complicated with mitral valve disease to provide the basis for the choice of surgical methods for such patients.Data and methods: We retrieved from January 2003 to August 2018,57 cases of HOCM with mitral valve disease were treated in our hospital.All 57 patients were treated with interventricular myocardial resection by conventional aortic incision Mitral valve operation was performed simultaneously on the basis of modified extended morrow operation,including 35 cases(61.4%)with mitral valve replacement(SM +MVR group),22 cases(38.6%)with mitral valvuloplasty(SM + MVP group),and all57 patients were analyzed with SF-36 health-related quality of life before and one year after operation.Follow up time(12-66 months).For the measurement data,the mean ±standard deviation is used to express the comparison between the mean of two samples,the t-test is used;for the qualitative data,the percentage is used,and the chi square test is used for the comparison between the two sample rates.All the data were analyzed by normal test and non parametric test.The differences between SM + MVP and SM +MVR groups before and after operation were analyzed by Wilcoxon(W)test or Mann Whitney U test.Results: At the same time,the implementation of mitral valve operation can greatly improve the clinical symptoms and long-term quality of life of patients with HOCM and mitral disease.For the two groups with similar baseline data,35 patients(61.4%)underwent mitral valve replacement at the same time(SM + MVR group)and22 patients(38.6%)underwent mitral valvuloplasty at the same time(SM + MVP group).Among them,one case in SM + MVP group died of multiple organ failure secondary to early low cardiac output syndrome on the third day after operation,one case in SM + MVR group died of sudden ventricular fibrillation on the ninth day after operation,the other 55 cases were discharged after operation,and there was no disease-related clinical death in the follow-up time.The perioperative mortality was3.5%.There was no significant difference between SM + MVP group and SM + MVR group in the time of intensive care and the number of days in Hospital;SM + MVP group needed more time of aortic occlusion than SM + MVR group,but the total cost of hospitalization was less.One year after the operation,the NYHA grade of the two groups was significantly improved compared with that before the operation.There was no grade III or IV and there was no difference between the two groups.The phenomenon of Sam disappeared basically and the mitral regurgitation was significantly improved in the reexamination echocardiography(3 cases in SM + MVP group and 2cases in SM + MVR group,all of them were mild).There was no significant difference between the two groups in the indexes of echocardiography(left atrial diameter,interventricular septum thickness,left ventricular outflow tract pressure difference,left ventricular ejection fraction)before operation,3 months after operation and 1 year after operation.The main indexes of echocardiography(left atrial diameter,interventricular septum thickness,left ventricular outflow tract pressure difference)in the two groups were significantly lower than that in the group before operation Although there was no statistical significance in the comparison within the standard group,it was within the normal range before and after operation.There was no significant difference in the indexes of echocardiography(left atrium diameter,interventricular septal thickness,left ventricular outflow tract pressure difference,left ventricular ejection fraction)between the two groups 3 months after operation and 1 year after operation.The main postoperative complications included: pulmonary infection in 13 cases(22.80%),pericardial effusion in 8 cases(14.04%),arrhythmia in 13 cases(22.81%),mitral valve leakage in 2 cases(3.51%),valve thrombus in 1 case(1.75%),tia2 cases(3.51%),subcutaneous hemorrhage in 2 cases(3.51%),gingival bleeding in tia2 cases(3.51%),gastrointestinal bleeding in 1 case(1.75%),among which the first three groups were all present The last six items did not appear in SM + MVP group.The SF-36 scores of the two groups in one year after operation were significantly higher than that before operation,and the difference was significant.The overall scores of GH,MH,HT in SM+ MVP group in one year after operation were higher than that in SM + MVR group,and the other dimensions were not significantly different.Conclusion: It is safe and effective to use the modified extended morrow procedure with mitral valvuloplasty or replacement at the same time in the treatment of patients with HOCM and mitral disease.Both of them can significantly reduce the left ventricular outflow tract pressure difference and improve the long-term quality of life of patients.The specific treatment of mitral valve in the same period should be determined by the detailed results of echocardiography before and during the operation.Compared with mitral valve replacement,the advantages of mitral valvuloplasty are better long-term quality of life and lower incidence of anticoagulation events.