{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:22:52Z","timestamp":1790796172992,"version":"4.1.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"06","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study evaluated the echocardiographic parameters and complication rates of surgical myectomy with concomitant anterior mitral leaflet extension (SM\u2009+\u2009AMLE) and isolated SM in hypertrophic obstructive cardiomyopathy (HOCM) patients.<\/jats:p>\n                  <jats:p>All HOCM patients undergoing SM\u2009+\u2009AMLE (2006\u20132015) and isolated SM (2015\u20132020) in our centre were analysed. The primary outcome was left ventricular outflow tract (LVOT)-gradient and surgical reoperation (SM\/mitral surgery). Secondary outcomes were aortic cross-clamping (ACC) time, iatrogenic ventricular septal defect (VSD), and mortality at 30-day and 3-year follow-up. Mixed-effects models assessed postoperative changes in LVOT-gradient measurements over time until a 3-year follow-up.<\/jats:p>\n                  <jats:p>This cohort (n\u2009=\u200959) consisted of 34 (58%) SM\u2009+\u2009AMLE and 25 (42%) isolated SM procedures. There were 32 (54%) males and 27 (46%) females with a mean age of 55\u2009\u00b1\u200913 years at the time of the intervention. Postoperatively, no differences were observed over time in the median LVOT-gradient (p\u2009=\u20090.34). In the SM\u2009+\u2009AMLE group, 6% (n\u2009=\u20092) required surgical reoperation (due to patch dehiscence) versus 0% in the SM group. In the SM\u2009+\u2009AMLE group, the ACC time was significantly higher (86\u2009minutes [interquartile range [IQR]: 74\u2013103]) than in the isolated SM group (48\u2009minutes [IQR: 39\u201357]; p\u2009&lt;\u2009001). In both groups, the VSD complication rate was 0%, and neither procedure led to death at 3-year follow-up.<\/jats:p>\n                  <jats:p>HOCM-patients who underwent SM\u2009+\u2009AMLE had comparable clinical and echocardiographic outcomes to patients who underwent isolated SM. This suggests that increasing procedural complexity may not improve outcomes. However, given potential confounding, this should be interpreted with caution, future prospective randomised controlled trials are necessary.<\/jats:p>","DOI":"10.1055\/a-2768-2815","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:11:48Z","timestamp":1765498308000},"page":"468-476","source":"Crossref","is-referenced-by-count":1,"title":["Surgical Myectomy with Anterior Mitral Leaflet Extension Versus Isolated Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy"],"prefix":"10.1055","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2567-9429","authenticated-orcid":false,"given":"Tijn J.P.","family":"Heeringa","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Hoogewerf","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romy","family":"Hegeman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands"},{"name":"Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri van","family":"Wylick","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Stecher","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten Jan","family":"Cramer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"De Zan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Koop","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald C.A.","family":"Meijer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolaas P.A.","family":"Zuithoff","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pim van der","family":"Harst","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Guglielmo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilonca","family":"Vaartjes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa M.","family":"Mokhles","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels P.","family":"van der Kaaij","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"issue":"37","key":"ref1","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC Guidelines for the management of cardiomyopathies","volume":"44","author":"E Arbelo","year":"2023","journal-title":"Eur Heart J"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.21037\/jtd-22-182","article-title":"Systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy: a narrative review","volume":"14","author":"S A Guigui","year":"2022","journal-title":"J Thorac Dis"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"329","DOI":"10.21037\/acs.2017.07.03","article-title":"Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience","volume":"6","author":"K D Kotkar","year":"2017","journal-title":"Ann Cardiothorac Surg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1016\/j.athoracsur.2020.09.011","article-title":"Late health status of patients undergoing myectomy for obstructive hypertrophic cardiomyopathy","volume":"111","author":"A Nguyen","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"ref5","first-page":"ehaf560","article-title":"Surgical myectomy for hypertrophic cardiomyopathy: procedural volume and outcomes","author":"T JP Heeringa","year":"2025","journal-title":"Eur Heart J"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"e016210","DOI":"10.1161\/JAHA.120.016210","article-title":"Outcomes in guideline-based class I indication versus earlier referral for surgical myectomy in hypertrophic obstructive cardiomyopathy","volume":"10","author":"A Alashi","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.amjcard.2014.12.017","article-title":"Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy","volume":"115","author":"P A Vriesendorp","year":"2015","journal-title":"Am J Cardiol"},{"issue":"25","key":"ref8","first-page":"e558","article-title":"2020 AHA\/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"142","author":"S R Ommen","year":"2020","journal-title":"Circulation"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/0735-1097(96)00103-9","article-title":"Initial results of combined anterior mitral leaflet extension and myectomy in patients with obstructive hypertrophic cardiomyopathy","volume":"28","author":"M J Kofflard","year":"1996","journal-title":"J Am Coll Cardiol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1161\/01.CIR.52.1.88","article-title":"Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients","volume":"52","author":"A G Morrow","year":"1975","journal-title":"Circulation"},{"key":"ref11","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4419-0318-1","volume-title":"Mixed-Effects Models in S and S-PLUS","author":"J C Pinheiro","year":"2000"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1016\/j.athoracsur.2007.12.082","article-title":"Guidelines for reporting mortality and morbidity after cardiac valve interventions","volume":"85","author":"C W Akins","year":"2008","journal-title":"Ann Thorac Surg"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1016\/j.jtcvs.2018.11.148","article-title":"Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center","volume":"157","author":"K Hodges","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1002\/ejhf.1038","article-title":"Long-term outcomes for different surgical strategies to treat left ventricular outflow tract obstruction in hypertrophic cardiomyopathy","volume":"20","author":"R Collis","year":"2018","journal-title":"Eur J Heart Fail"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1161\/CIRCULATIONAHA.112.000849","article-title":"Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction","volume":"128","author":"M Y Desai","year":"2013","journal-title":"Circulation"},{"issue":"S 01","key":"ref16","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s12055-019-00817-y","article-title":"Management of the mitral valve in patients with obstructive hypertrophic cardiomyopathy","volume":"36","author":"J H Hong","year":"2020","journal-title":"Indian J Thorac Cardiovasc Surg"},{"issue":"14","key":"ref17","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/j.jacc.2016.07.735","article-title":"Mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy: implications for concomitant valve procedures","volume":"68","author":"J H Hong","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.mayocp.2018.07.022","article-title":"Septal myectomy in hypertrophic cardiomyopathy: national outcomes of concomitant mitral surgery","volume":"94","author":"K A Holst","year":"2019","journal-title":"Mayo Clin Proc"},{"issue":"17","key":"ref19","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1161\/01.CIR.0000092912.57140.14","article-title":"Sustained improvement after combined anterior mitral leaflet extension and myectomy in hypertrophic obstructive cardiomyopathy","volume":"108","author":"C van der Lee","year":"2003","journal-title":"Circulation"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ijcard.2020.08.059","article-title":"Impact of sex on timing and clinical outcome of septal myectomy for obstructive hypertrophic cardiomyopathy","volume":"323","author":"R Huurman","year":"2021","journal-title":"Int J Cardiol"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jtcvs.2020.12.143","article-title":"Is anterior mitral valve leaflet length important in outcome of septal myectomy for obstructive hypertrophic cardiomyopathy?","volume":"165","author":"J Lentz Carvalho","year":"2023","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2768-2815.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:48:22Z","timestamp":1787870902000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2768-2815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":21,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2026,8,27]]},"published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2768-2815","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,11]]},"published":{"date-parts":[[2025,12,11]]}}}