Late clinical outcome of transient intraoperative systolic anterior motion post mitral valve repair

Rafael Kuperstein, Dan Spiegelstein, Gilad Rotem, Michael Stein, Alexander Kogan, Leonid Sternik, Ehud Raanani*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objective Systolic anterior motion (SAM) after mitral valve repair with significant mitral regurgitation requires immediate reintervention. Transient SAM immediately after repair is usually managed by hemodynamic maneuvers. We investigated the late clinical and echocardiographic significance of postoperative transient SAM. Methods Between 2004 and 2013, mitral valve repair was performed on 549 consecutive patients with degenerative mitral valve disease. Of the 45 patients (8.2%) identified with postrepair SAM, 5 needed immediate reintervention. Hemodynamic maneuvers, such as preload and afterload augmentation and rate control, effectively abolished SAM in 40 patients (SAM). They were followed and compared with the remaining 509 patients (non-SAM). Results Mean clinical follow-up was 54 ± 28 and 31 ± 26 months and was available in 100% and 95% (SAM and non-SAM) patients, respectively. One hospital death occurred in each group (P =.14). At follow-up, 2 patients (0.3%) showed significant SAM with left ventricular outflow tract obstruction, which resolved in 1 patient after beta-blocker therapy. SAM patients underwent exercise stress echocardiography: 1 patient showed left ventricular outflow tract obstruction that worsened after exercise. At 5 years, freedom from moderate or severe mitral regurgitation and New York Heart Association functional class III-IV was 85% versus 92% (P =.27) and 81% versus 92% (P =.15), and freedom from reoperation was 100% and 96% (P =.4), in SAM and non-SAM patients, respectively. Conclusions Late postoperative exercise stress echocardiogram revealed low incidence of SAM in patients with immediate postrepair transient SAM. All other late clinical outcomes were similar to those of non-SAM repair patients. Conservative management of intraoperative transient SAM is both successful and reliable.

Original languageEnglish
Pages (from-to)471-476
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number2
DOIs
StatePublished - 1 Feb 2015
Externally publishedYes

Fingerprint

Dive into the research topics of 'Late clinical outcome of transient intraoperative systolic anterior motion post mitral valve repair'. Together they form a unique fingerprint.

Cite this