Modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy: A single-center retrospective study in 318 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jie ^1,2 , WENG Fan ² , CHEN Nan ² , SUN Yongxin ² ,  GUO Changfa ² , WANG Chunsheng ² , LIN Yi ² , DING Wenjun ²

1. Department of Cardiovascular Surgery, Huai'an Hospital Affiliated of Yangzhou University, Huai'an Fifth People's Hospital, Huai'an, 223300, Jiangsu, P. R. China;
2. Department of Cardiovascular Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200000, P. R. China;

Corresponding author：

GUO Changfa, Email: guo.changfa@zs-hospital.sh.cn

Keywords：

Hypertrophic obstructive cardiomyopathy; modified Morrow procedure; systolic anterior motion; Ⅲ° atrioventricular block

DOI：

10.7507/1007-4848.202401018

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Objective To summarize the clinical efficacy of modified Morrow surgery in the treatment of hypertrophic obstructive cardiomyopathy. Methods A retrospective analysis was conducted on the clinical data of patients with hypertrophic obstructive cardiomyopathy treated with modified Morrow surgery at Zhongshan Hospital Affiliated to Fudan University from 2020 to 2023. Results A total of 318 patients were enrolled, including 156 males and 162 females, with an average age of 55.6±13.1 years. Preoperative echocardiography showed a mean interventricular septal thickness of 18.1±3.8 cm, peak left ventricular outflow tract pressure difference of 86.4±24.9 mm Hg. The surgery time was 162.3±51.0 min, extracorporeal circulation time was 80.9±31.0 min, and aortic occlusion time was 44.8±20.8 min. After the surgery, transesophageal echocardiography showed that the interventricular septal thickness was 11.0±1.8 cm and left ventricular outflow tract peak pressure difference was 9.4±5.1 mm Hg. The incidence rate of postoperative complete left bundle branch block was 45.3%, Ⅲ° atrioventricular block was 3.8%, and postoperative newly developed atrial fibrillation was 3.1%. The postoperative hospital stay was 6.6±4.9 days, and one perioperative death occurred, with a mortality rate of 0.3%. The follow-up time was10.3±9.4 months, during which the transthoracic echocardiography revealed a ventricular septal thickness of 12.9±2.9 cm and a peak left ventricular outflow tract pressure difference of 13.9±10.0 mm Hg. Conclusion The modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy is safe and effective, with good results in the short and medium term.

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2.	Canepa M, Olivotto I. Evolving epidemiology of hypertrophic cardiomyopathy: Shifting the focus from instant to lifetime risk awareness. Circ Heart Fail, 2022, 15(9): e009873.
3.	Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2020, 142(25): e533-e557.533-557.
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5.	刘方钰, 季强, 王毓琳, 等. 梗阻性肥厚型心肌病的外科治疗: 单中心5年421例经验总结. 中华外科杂志, 2023, 61(3): 201-208.
6.	国家心血管病中心心肌病专科联盟, 中国医疗保健国际交流促进会心血管病精准医学分会"中国成人肥厚型心肌病诊断与治疗指南2023"专家组. 中国成人肥厚型心肌病诊断与治疗指南2023. 中国循环杂志, 2023, 38(1): 102-104.
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8.	魏翔. 肥厚型梗阻性心肌病外科治疗进展. 临床外科杂志, 2023, 31(9): 801-803.
9.	Weissler-Snir A, Adler A, Rakowski H. MV Surgery as Adjunct to Surgical Myectomy for Obstructive HCM: Less Is More Than Enough. J Am Coll Cardiol, 2016, 68(14): 1505-1508.
10.	Nguyen A, Schaff HV, Nishimura RA, et al. Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy? Eur J Cardiothorac Surg, 2018, 53(3): 582-589.
11.	Hodges K, Rivas CG, Aguilera J, et al. Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center. J Thorac Cardiovasc Surg, 2019, 157(6): 2289-2299.
12.	Malcolmson J, Shipolini A, Mohiddin S, et al. The mitral valve in hypertrophic cardiomyopathy. Curr Opin Cardiol, 2023, 38(5): 415-423.
13.	Wei P, Liu J, Ma J, et al. Thoracoscopic trans-mitral septal myectomy for hypertrophic obstructive cardiomyopathy in the elderly. Front Cardiovasc Med, 2022, 9: 827860.
14.	Ji Q, Wang YL, Yang Y, et al. Mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: A single-center experience with 168 cases. J Cardiothorac Surg, 2021, 16(1): 25.
15.	蒙延海, 刘平, 张燕博, 等. 肥厚型梗阻性心肌病改良扩大Morrow术后新发心房颤动的危险因素分析及术前肾小球率过滤的预测价值. 中国胸心血管外科临床杂志, 2021, 28(10): 1234-1241.
16.	蒙延海, 王水云, 张燕搏, 等. 外科治疗肥厚型梗阻性心肌病合并冠心病的处理策略及早中期结果. 中国胸心血管外科临床杂志, 2019, 26(2): 142-147.
17.	蒙延海, 王水云, 张燕博, 等. 外科治疗肥厚型心肌病合并心肌桥的临床结果分析. 中国循环杂志, 2018, 33(8): 37-38.

1. Nishimura RA, Seggewiss H, Schaff HV. Hypertrophic obstructive cardiomyopathy: Surgical myectomy and septal ablation. Circ Res, 2017, 121(7): 771-783.
2. Canepa M, Olivotto I. Evolving epidemiology of hypertrophic cardiomyopathy: Shifting the focus from instant to lifetime risk awareness. Circ Heart Fail, 2022, 15(9): e009873.
3. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2020, 142(25): e533-e557.533-557.
4. Maron BJ, Dearani JA, Smedira NG, et al. Ventricular septal myectomy for obstructive hypertrophic cardiomyopathy (analysis spanning 60 years of practice): AJC expert panel. Am J Cardiol, 2022, 180: 124-139.
5. 刘方钰, 季强, 王毓琳, 等. 梗阻性肥厚型心肌病的外科治疗: 单中心5年421例经验总结. 中华外科杂志, 2023, 61(3): 201-208.
6. 国家心血管病中心心肌病专科联盟, 中国医疗保健国际交流促进会心血管病精准医学分会"中国成人肥厚型心肌病诊断与治疗指南2023"专家组. 中国成人肥厚型心肌病诊断与治疗指南2023. 中国循环杂志, 2023, 38(1): 102-104.
7. 孙杰军, 何继强. 肥厚型梗阻性心肌病的治疗研究进展. 心肺血管病杂志, 2023, 42(6): 628-632.
8. 魏翔. 肥厚型梗阻性心肌病外科治疗进展. 临床外科杂志, 2023, 31(9): 801-803.
9. Weissler-Snir A, Adler A, Rakowski H. MV Surgery as Adjunct to Surgical Myectomy for Obstructive HCM: Less Is More Than Enough. J Am Coll Cardiol, 2016, 68(14): 1505-1508.
10. Nguyen A, Schaff HV, Nishimura RA, et al. Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy? Eur J Cardiothorac Surg, 2018, 53(3): 582-589.
11. Hodges K, Rivas CG, Aguilera J, et al. Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center. J Thorac Cardiovasc Surg, 2019, 157(6): 2289-2299.
12. Malcolmson J, Shipolini A, Mohiddin S, et al. The mitral valve in hypertrophic cardiomyopathy. Curr Opin Cardiol, 2023, 38(5): 415-423.
13. Wei P, Liu J, Ma J, et al. Thoracoscopic trans-mitral septal myectomy for hypertrophic obstructive cardiomyopathy in the elderly. Front Cardiovasc Med, 2022, 9: 827860.
14. Ji Q, Wang YL, Yang Y, et al. Mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: A single-center experience with 168 cases. J Cardiothorac Surg, 2021, 16(1): 25.
15. 蒙延海, 刘平, 张燕博, 等. 肥厚型梗阻性心肌病改良扩大Morrow术后新发心房颤动的危险因素分析及术前肾小球率过滤的预测价值. 中国胸心血管外科临床杂志, 2021, 28(10): 1234-1241.
16. 蒙延海, 王水云, 张燕搏, 等. 外科治疗肥厚型梗阻性心肌病合并冠心病的处理策略及早中期结果. 中国胸心血管外科临床杂志, 2019, 26(2): 142-147.
17. 蒙延海, 王水云, 张燕博, 等. 外科治疗肥厚型心肌病合并心肌桥的临床结果分析. 中国循环杂志, 2018, 33(8): 37-38.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesModified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy: A single-center retrospective study in 318 patients

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