Concomitant Ozaki procedure and septal myectomy in patients with severe aortic stenosis

Abstract

Objective. The presence of marked asymmetric septal hypertrophy in patients with aortic stenosis may lead to dynamic obstruction of the left ventricular outflow tract in addition to fixed obstruction at the level of the aortic valve. The persistence of an increased subvalvular gradient may worsen both early and long-term results. At the same time, surgical tactics in combination of two pathologies is currently undefined.Aim: To analyze the early and mid-term results of concomitant Ozaki procedure and septal myectomy.Patients and Methods. This case series included 13 patients with severe aortic stenosis and asymmetric septal hypertrophy who underwent aortic valve reconstruction according to the Ozaki technique and septal myectomy according to Morrow. The mean age was 68 years [from 50 to 79]. In 12 of 13 patients, the aortic valve annulus was less than 21 mm. Early and mid-term (29.5 months) clinical results, complications specific for septal myectomy, hemodynamic parameters at the aortic valve and left ventricular outflow tract were evaluated.Results. 1 patient died at the hospitalization stage. There were no cases of repeated aortic clamping for aortic valve prosthesis, additional resection of interventricular septum, acute defect of interventricular septum. One patient required permanent pacing due to complete transverse heart block. There were no lethal outcomes during the follow-up. Good hemodynamic results were achieved in all patients: mean aortic valve area 2.2 cm2 (from 1.4 to 3.0 cm2 ); mean transvalvular gradient 11 mmHg (from 6 to 15 mmHg); basal interventricular septum thickness 11.2 mm, left ventricular outflow tract gradient 3.9 mmHg.Conclusion. In our case series of 13 patients with aortic stenosis and subvalvular left ventricular outflow tract obstruction, Ozaki procedure and septal myectomy resulted in good early and mid-term clinical and hemodynamic outcomes. Septal myectomy is a safe procedure without increasing the risk of complications. However, large prospective randomized comparative studies are needed to provide reliable evidence of the benefit of combined intervention and to develop optimal recommendations.