{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:31:28Z","timestamp":1783089088549,"version":"3.54.6"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Alfieri Heart Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2002<\/jats:title>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The aim of this study was to assess the long-term outcomes of different surgical strategies in patients with hypertrophic obstructive cardiomyopathy (HOCM) with septal thickness \u226418 mm and systolic anterior motion (SAM)-related moderate-to-severe mitral regurgitation (MR).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Seventy-six HOCM patients with septal thickness 17 [16; 18]\u2009mm, resting left ventricle outflow tract gradient 60 [41; 85] mmHg and SAM-related MR \u22652+\/4+, underwent septal myectomy alone (54%) or mitral valve (MV) surgery \u00b1 myectomy (46%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>No hospital death and no ventricular septal defect occurred. Patients undergoing MV surgery \u00b1 myectomy had longer cardiopulmonary bypass and X-clamp times (77 [60\u2013106] vs 51 [44\u201362] min, P\u2009&amp;lt;\u20090.001 and 56 [45\u201377] vs 32 [28\u201341] min, P\u2009&amp;lt;\u20090.001) and higher incidence of low output syndrome (11% vs 0%, P\u2009=\u20090.04). Follow-up was 98.6% complete, median 8\u2009years [3\u201311]. There were no statistically significant differences in overall survival (P\u2009=\u20090.069) with survival rates at 9\u2009years of 96\u2009\u00b1\u20094% in the myectomy alone group and 81\u2009\u00b1\u20098% in the MV surgery \u00b1 myectomy one. At 9\u2009years, cumulative incidence function of cardiac death was 12\u2009\u00b1\u20096% in the MV surgery \u00b1 myectomy group vs 0% in the myectomy one, P\u2009=\u20090.06. Multivariable analysis identified age and previous septal alcoholization as predictors of cardiac death (hazard ratio (HR)\u2009=\u20091.1, 95% confidence interval (CI) 1.0\u20131.1, P\u2009=\u20090.004 and HR\u2009=\u20092.9, 95% CI 1.0\u20138.3, P\u2009=\u20090.042). The 9-year cumulative incidence function of recurrence of MR \u22652+, with death as competing risk, was 3\u2009\u00b1\u20092.8% in the MV surgery \u00b1 myectomy group vs 25\u2009\u00b1\u20096.9% in the myectomy one, P\u2009=\u20090.005.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In HOCM patients with moderate septal thickness and SAM-related MR, as the degree of septal hypertrophy decreases, addressing the abnormalities of the MV apparatus may become necessary to provide a durable resolution of left ventricle outflow tract obstruction and SAM-related MR. However, performing myectomy alone, whenever possible, seems to be associated to a better postoperative course and a trend towards lower cardiac mortality at follow-up, despite a higher rate of residual moderate MR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab097","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T12:39:53Z","timestamp":1612874393000},"page":"244-251","source":"Crossref","is-referenced-by-count":14,"title":["Hypertrophic cardiomyopathy with moderate septal thickness and mitral regurgitation: long-term surgical results"],"prefix":"10.1093","volume":"60","author":[{"given":"Elisabetta","family":"Lapenna","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Nisi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8775-3464","authenticated-orcid":false,"given":"Davide","family":"Carino","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Bargagna","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Ruggeri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0259-0844","authenticated-orcid":false,"given":"Edoardo","family":"Zancanaro","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0081-6232","authenticated-orcid":false,"given":"Benedetto","family":"Del Forno","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-1678","authenticated-orcid":false,"given":"Davide","family":"Schiavi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eustachio","family":"Agricola","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Castiglioni","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1065-8052","authenticated-orcid":false,"given":"Ottavio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-7437","authenticated-orcid":false,"given":"Michele","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"2021080208044467300_ezab097-B1","doi-asserted-by":"crossref","first-page":"e003132","DOI":"10.1161\/CIRCIMAGING.115.003132","article-title":"Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy patients without severe septal hypertrophy: implications of mitral valve and papillary muscle abnormalities assessed using cardiac magnetic resonance and echocardiography","volume":"8","author":"Patel","year":"2015","journal-title":"Circ Cardiovasc 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