Comparison of Early and Mid-Term Outcomes After Classic and Modified Morrow Septal Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy

Karaarslan, Mustafa; Beyazal, Osman Fehmi; Yanartaş, Mehmed

doi:10.21470/1678-9741-2023-0205

Mustafa Karaarslan

Substantial contributions to the conception or design of the work

the acquisition

analysis

and interpretation of data for the work

drafting the work or revising it critically for important intellectual content

final approval of the version to be published

Department of Cardiovascular Surgery, Kartal Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey

Osman Fehmi Beyazal Correspondence Address: Osman Fehmi Beyazal, https://orcid.org/0000-0001-6211-0676, Department of Cardiovascular Surgery, Başakşehir Çam and Sakura City Hospital, Başakşehir Olympic Boulevard Road, Başakşehir, İstanbul, Turkey, Zip Code: 34480, E-mail: osmanfehmibeyazal@gmail.com

Substantial contributions to the analysis of data for the work

drafting the work or revising it critically for important intellectual content

final approval of the version to be published

Department of Cardiovascular Surgery, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey

https://orcid.org/0000-0001-6211-0676

Mehmed Yanartaş

Substantial contributions to the conception or design of the work

drafting the work or revising it critically for important intellectual content

final approval of the version to be published

Department of Cardiovascular Surgery, Kartal Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey

Correspondence Address: Osman Fehmi Beyazal, https://orcid.org/0000-0001-6211-0676, Department of Cardiovascular Surgery, Başakşehir Çam and Sakura City Hospital, Başakşehir Olympic Boulevard Road, Başakşehir, İstanbul, Turkey, Zip Code: 34480, E-mail: osmanfehmibeyazal@gmail.com

No conflict of interest.

Tables (5)

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Abbreviations, Acronyms & Symbols ASD = Atrial septal defect LVOT = Left ventricular outflow tract AV = Atrioventricular MR = Mitral regurgitation BMI = Body mass index MRA = Mitral ring annuloplasty CABG = Coronary artery bypass grafting MVR = Mitral valve replacement COPD = Chronic obstructive pulmonary disease NOAF = New-onset atrial fibrillation CPB = Cardiopulmonary bypass NSR = Normal sinus rhythm EF = Ejection fraction Q1 = First quarter EuroSCORE = European System for Cardiac Operative Risk Evaluation Q3 = Third quarter HOCM = Hypertrophic obstructive cardiomyopathy SAM = Systolic anterior motion ICU = Intensive care unit SD = Standard deviation IVS = Interventricular septum TTE = Transthoracic echocardiographic LAD = Left atrial diameter XCL = Cross-clamping LBBB = Left bundle branch block

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Table 1
Patients’ demographics, clinical characteristics, intraoperative data, and postoperative data.

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Table 2
Comparison of preoperative and postoperative echocardiographic findings between classic Morrow and modified Morrow groups.

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Table 3
Comparison of preoperative and postoperative electrocardiographic and echocardiographic findings between classic and modified Morrow groups.

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Table 4
Comparison of preoperative and postoperative gradient differences between classic and modified Morrow groups.

Abbreviations, Acronyms & Symbols
ASD	= Atrial septal defect	LVOT	= Left ventricular outflow tract
AV	= Atrioventricular	MR	= Mitral regurgitation
BMI	= Body mass index	MRA	= Mitral ring annuloplasty
CABG	= Coronary artery bypass grafting	MVR	= Mitral valve replacement
COPD	= Chronic obstructive pulmonary disease	NOAF	= New-onset atrial fibrillation
CPB	= Cardiopulmonary bypass	NSR	= Normal sinus rhythm
EF	= Ejection fraction	Q₁	= First quarter
EuroSCORE	= European System for Cardiac Operative Risk Evaluation	Q₃	= Third quarter
HOCM	= Hypertrophic obstructive cardiomyopathy	SAM	= Systolic anterior motion
ICU	= Intensive care unit	SD	= Standard deviation
IVS	= Interventricular septum	TTE	= Transthoracic echocardiographic
LAD	= Left atrial diameter	XCL	= Cross-clamping
LBBB	= Left bundle branch block

	Classic Morrow (n=28)	Modified Morrow (n=20)	P-value
	Median (Q₁-Q₃), Mean±SD or n (%)	Median (Q₁-Q₃), Mean±SD or n (%)	P-value
Sex, female	12 (42.86)	12 (60.0)	0.24¹ 1 Chi-square test
Age (years)	51.79±16.02	45.75±16.7	0.21² 2 Independent samples t-test
Height (cm)	163.29±8.06	160.75±9.57	0.32² 2 Independent samples t-test
Weight (kg)	77.21±11.87	75±12.30	0.53² 2 Independent samples t-test
BMI (m² 2 Independent samples t-test )	29.09±5.15	29.01±3.95	0.95² 2 Independent samples t-test
Diabetes mellitus	16 (57.14)	11 (55.0)	0.88¹ 1 Chi-square test
COPD	12 (42.86)	5 (25.0)	0.20¹ 1 Chi-square test
EuroSCORE II	0.8 (0.53-1.76)	0.8 (0.60-0.98)	0.65³ 3 Mann-Whitney U test
Intervention for mitral valve	13 (46.4)	7 (35.0)	0.42¹ 1 Chi-square test
Concomitant MVR	9 (32.14)	7 (35.0)	0.83¹ 1 Chi-square test
Concomitant MRA	4 (14.29)	0 (0)	0.13⁴ 4 Fisher’s exact test
CABG	2 (7.14)	2 (10.0)	1.00⁴ 4 Fisher’s exact test
ASD closure	1 (3.57)	1 (5.0)	1.00⁴ 4 Fisher’s exact test
XCL time (min.)	76 (53.25-96.5)	73.5 (50.75-106.0)	0.73³ 3 Mann-Whitney U test
CPB time (min.)	111 (87.25-162)	118.0 (81.25-146.0)	0.86³ 3 Mann-Whitney U test
Hypothermia (°C)	28.64±2.41	29.45±2.37	0.25³ 3 Mann-Whitney U test
Internal pacemaker	2 (7.14)	1 (5.0)	0.76¹ 1 Chi-square test
External pacemaker	9 (32.14)	4 (20.0)	0.35¹ 1 Chi-square test
Atrial fibrillation	5 (17.86)	5 (25.0)	0.54¹ 1 Chi-square test
Total drainage (ml)	450.0 (362.5-750.0)	500.0 (312.5-825.0)	0.90³ 3 Mann-Whitney U test
Extubation time (hours)	8.0 (6.0-12.0)	7.5 (6.0-12.0)	0.31³ 3 Mann-Whitney U test
ICU stay (days)	3.0 (2.0-4.0)	2.0 (1.0-4.75)	0.92³ 3 Mann-Whitney U test
Hospital stay (days)	7.5 (5.0-13.0)	7.5 (6.0-13.25)	0.64³ 3 Mann-Whitney U test
Mortality	7 (25.0)	0 (0)	0.01¹ 1 Chi-square test

	Classic Morrow (n=28)	Modified Morrow (n=20)	P-value
	Median (Q₁-Q₃), Mean±SD or n (%)	Median (Q₁-Q₃), Mean±SD or n (%)	P-value
Preoperative gradient (mmHg)	75.0 (55.25-81.5)	77.5 (65.0-98.0)	0.22¹ 1 Mann-Whitney U test
Postoperative gradient (mmHg)	37.0 (29.75-47.75)	31.5 (28.5-35.0)	0.11¹ 1 Mann-Whitney U test
Gradient at postoperative 3 months (mmHg)	30.0 (23.75-33.5)	30.0 (21.0-31.0)	0.23¹ 1 Mann-Whitney U test
Gradient at postoperative 12 months (mmHg)	28.0 (22.5-30.0)	28.0 (20.0-31.0)	0.81¹ 1 Mann-Whitney U test
Preoperative IVS thickness (mm)	2.32±0.29	2.31±0.34	0.85² 2 Student’s t-test
Preoperative EF (%)	63.75±2.92	63.25±3.35	0.34² 2 Student’s t-test
Preoperative posterior wall (mm)	1.48±0.29	1.50±0.39	0.20² 2 Student’s t-test
Preoperative LAD (mm)	4.12±0.52	4.04±0.87	0.16² 2 Student’s t-test
Preoperative moderate MR	6 (21.43)	6 (30)	0.49³ 3 Chi-square test
Preoperative severe MR	9 (32.14)	4 (20)	0.35³ 3 Chi-square test
Postoperative IVS thickness (mm)	1.91±0.29	1.89±0.28	0.75² 2 Student’s t-test
Postoperative EF (%)	63.39±3.05	62.5±3.44	0.24² 2 Student’s t-test
Postoperative posterior wall (mm)	1.36±0.26	1.43±0.32	0.31² 2 Student’s t-test
Postoperative LAD (mm)	3.89±0.54	3.97±0.69	0.30² 2 Student’s t-test
Postoperative moderate MR	2 (7.14)	0 (0)	0.50⁴ 4 Fisher’s exact test
Postoperative severe MR	0 (0)	0 (0)	-

		Preoperative	Postoperative	P-value
		Median (Q1-Q3), Mean±SD or n (%)	Median (Q1-Q3), Mean±SD or n (%)	P-value
Classic Morrow (n=28)	IVS thickness (mm)	2.32±0.29	1.91±0.29	< 0.001¹ 1 Independent Samples t-test
	EF (%)	63.75±2.92	63.39±3.05	0.41¹ 1 Independent Samples t-test
	Posterior wall (mm)	1.48±0.29	1.36±0.26	0.01¹ 1 Independent Samples t-test
	LAD (mm)	4.12±0.52	3.89±0.54	0.01¹ 1 Independent Samples t-test
	NSR	26 (92.86)	14 (50)	< 0.01² 2 Wilcoxon signed-rank test
	LBBB	2 (7.14)	8 (28.57)	0.03² 2 Wilcoxon signed-rank test
	AV block	0 (0)	6 (21.43)	0.01² 2 Wilcoxon signed-rank test
	Atrial fibrillation	0 (0)	5 (17.9)	0.02² 2 Wilcoxon signed-rank test
	Moderate MR	6 (21.43)	2 (7.14)	0.04² 2 Wilcoxon signed-rank test
	Severe MR	9 (32.14)	0 (0)	< 0.001² 2 Wilcoxon signed-rank test
Modified Morrow (n=20)	IVS thickness (mm)	2.31±0.34	1.89±0.28	< 0.001¹ 1 Independent Samples t-test
	EF (%)	63.25±3.35	62.5±3.44	0.08¹ 1 Independent Samples t-test
	Posterior wall (mm)	1.50±0.39	1.43±0.32	0.03¹ 1 Independent Samples t-test
	LAD (mm)	4.04±0.87	3.97±0.69	0.72¹ 1 Independent Samples t-test
	NSR	18 (90)	14 (70)	0.04² 2 Wilcoxon signed-rank test
	LBBB	2 (10)	5 (25)	0.08² 2 Wilcoxon signed-rank test
	AV block	0 (0)	1 (5)	0.02² 2 Wilcoxon signed-rank test
	Atrial fibrillation	0 (0)	5 (25)	0.02² 2 Wilcoxon signed-rank test
	Moderate MR	6 (30)	0 (0)	0.01² 2 Wilcoxon signed-rank test
	Severe MR	4 (20)	0 (0)	0.04² 2 Wilcoxon signed-rank test

		Classic Morrow (n=28)	Modified Morrow (n=20)	P-value
		Median (Q1-Q3) or n (%)	Median (Q1-Q3) or n (%)
∆ Gradient		39.0 (26.0-50.0)	70.0 (61.25-81.5)	< 0.001¹ 1 Mann-Whitney U test
∆ IVS thickness		0.40 (0.3-0.6)	0.45 (0.33-0.5)	0.95¹ 1 Mann-Whitney U test
∆ EF		0 (0-0)	0 (0-0)	0.55¹ 1 Mann-Whitney U test
∆ Posterior wall		0 (0-0.1)	0.05 (0-0.18)	0.47¹ 1 Mann-Whitney U test
∆ LAD		0.20 (0-0.5)	0.25 (-0.43-0.4)	0.46¹ 1 Mann-Whitney U test
∆ MR	Same	11 (39.29)	8 (40)	0.96¹ 1 Mann-Whitney U test
	Better	16 (57.14)	12 (60)	0.84¹ 1 Mann-Whitney U test
	Worse	1 (3.57)	0 (0)	0.39¹ 1 Mann-Whitney U test

[1] Correspondence Address: Osman Fehmi Beyazal, https://orcid.org/0000-0001-6211-0676, Department of Cardiovascular Surgery, Başakşehir Çam and Sakura City Hospital, Başakşehir Olympic Boulevard Road, Başakşehir, İstanbul, Turkey, Zip Code: 34480, E-mail: osmanfehmibeyazal@gmail.com

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Comparison of Early and Mid-Term Outcomes After Classic and Modified Morrow Septal Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy

ABSTRACT

Introduction:

Methods:

Results:

Conclusion: