{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:31:26Z","timestamp":1783089086072,"version":"3.54.6"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T00:00:00Z","timestamp":1614988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,11]]},"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>Left ventricular outflow tract obstruction causes symptoms of heart failure in most patients with hypertrophic cardiomyopathy. Resection of the secondary mitral valve (MV) chordae has recently been shown to move the MV apparatus posteriorly, thereby eradicating the outflow gradient. The aim of this study was to evaluate whether secondary chordal resection concomitant to septal myectomy improves outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Between 2005 and 2020, a total of 165 patients underwent septal myectomy without MV repair or replacement in our Medical Center. Secondary MV chordal resection was performed in 60 patients, and their outcomes were compared with those of the remaining 105 patients who did not undergo chordal resection (controls). Mean age was 61\u2009\u00b1\u200913 and 58\u2009\u00b1\u200916\u2009years, respectively (P\u2009=\u20090.205).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>There were no in-hospital deaths throughout the entire cohort. Of those patients who underwent secondary chordal resection, New York Heart Association functional class decreased from 3 (interquartile range 2\u20133) preoperatively to 1 (interquartile range 1\u20132) postoperatively (P\u2009&amp;lt;\u20090.001), and resting outflow gradient decreased from 91\u2009\u00b1\u200939\u2009mmHg to 13\u2009\u00b1\u20098 mmHg (86% change, P\u2009&amp;lt;\u20090.001). Compared with controls, patients who underwent secondary chordal resection had a significant lower resting outflow gradient at follow-up (14\u2009\u00b1\u20097 mmHg vs 21\u2009\u00b1\u200915\u2009mmHg, P\u2009=\u20090.002). The rate of moderate or more than moderate mitral regurgitation at 5 years was 2% in the secondary chordal resection group and 5% in the controls (hazard ratio 1.05, confidence interval 0.11\u201310.32; P\u2009=\u20090.965).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In this observational study, we report that secondary chordal resection concomitant to septal myectomy for left ventricular outflow tract obstruction is safe, relieves heart failure symptoms and reduces left ventricular outflow tract gradient in appropriately selected patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab116","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T20:13:14Z","timestamp":1613160794000},"page":"699-707","source":"Crossref","is-referenced-by-count":17,"title":["Secondary chordal resection with septal myectomy for treatment of symptomatic obstructive hypertrophic cardiomyopathy"],"prefix":"10.1093","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3292-821X","authenticated-orcid":false,"given":"Eilon","family":"Ram","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehud","family":"Schwammenthal","sequence":"additional","affiliation":[{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"},{"name":"Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Kuperstein","sequence":"additional","affiliation":[{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"},{"name":"Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer","family":"Jamal","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7674-2292","authenticated-orcid":false,"given":"Eyal","family":"Nahum","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonid","family":"Sternik","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehud","family":"Raanani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,6]]},"reference":[{"key":"2021091118365620100_ezab116-B1","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/S0735-1097(99)00039-X","article-title":"Clinical profile of hypertrophic cardiomyopathy identified de novo in rural communities","volume":"33","author":"Maron","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"2021091118365620100_ezab116-B2","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1093\/eurheartj\/ehq136","article-title":"Clinicopathological profiles of progressive heart failure in hypertrophic cardiomyopathy","volume":"31","author":"Melacini","year":"2010","journal-title":"Eur Heart J"},{"key":"2021091118365620100_ezab116-B3","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s10741-018-09767-w","article-title":"Review on sudden death risk reduction after septal reduction therapies in hypertrophic obstructive cardiomyopathy","volume":"24","author":"Rigopoulos","year":"2019","journal-title":"Heart Fail Rev"},{"key":"2021091118365620100_ezab116-B4","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1093\/eurheartj\/ehu284","article-title":"2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)","volume":"35","author":"Authors\/Task Force","year":"2014","journal-title":"Eur Heart J"},{"key":"2021091118365620100_ezab116-B5","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jchf.2015.06.011","article-title":"A systematic review and meta-analysis of long-term outcomes after septal reduction therapy in patients with hypertrophic cardiomyopathy","volume":"3","author":"Liebregts","year":"2015","journal-title":"JACC Heart Fail"},{"key":"2021091118365620100_ezab116-B6","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.jacc.2005.02.090","article-title":"Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy","volume":"46","author":"Ommen","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2021091118365620100_ezab116-B7","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.jtcvs.2014.05.028","article-title":"Residual and recurrent gradients after septal myectomy for hypertrophic cardiomyopathy-mechanisms of obstruction and outcomes of reoperation","volume":"148","author":"Cho","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021091118365620100_ezab116-B8","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jtcvs.2018.08.062","article-title":"Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: a propensity score-matched cohort","volume":"157","author":"Nguyen","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021091118365620100_ezab116-B9","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1016\/j.jacc.2015.07.069","article-title":"Transaortic chordal cutting: mitral valve repair for obstructive hypertrophic cardiomyopathy with mild septal hypertrophy","volume":"66","author":"Ferrazzi","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2021091118365620100_ezab116-B10","doi-asserted-by":"crossref","first-page":"318","DOI":"10.21037\/acs.2017.04.03","article-title":"Surgical treatment for hypertrophic cardiomyopathy: a historical perspective","volume":"6","author":"Hang","year":"2017","journal-title":"Ann Cardiothorac Surg"},{"key":"2021091118365620100_ezab116-B11","doi-asserted-by":"crossref","first-page":"426","DOI":"10.21037\/acs.2017.04.05","article-title":"Transaortic mitral valve secondary chordal cutting in patients with obstructive hypertrophic cardiomyopathy and mild septal hypertrophy","volume":"6","author":"Binaco","year":"2017","journal-title":"Ann Cardiothorac Surg"},{"key":"2021091118365620100_ezab116-B12","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1016\/j.amjcard.2007.07.020","article-title":"Frequency and mechanism of persistent systolic anterior motion and mitral regurgitation after septal ablation in obstructive hypertrophic cardiomyopathy","volume":"100","author":"Delling","year":"2007","journal-title":"Am J Cardiol"},{"key":"2021091118365620100_ezab116-B13","first-page":"603","article-title":"The role of Chordae tendineae in mitral valve competence","volume":"14","author":"Espino","year":"2005","journal-title":"J Heart Valve Dis"},{"key":"2021091118365620100_ezab116-B14","doi-asserted-by":"crossref","first-page":"3124","DOI":"10.1161\/01.CIR.96.9.3124","article-title":"Mitral subvalvular apparatus: different functions of primary and secondary chordae","volume":"96","author":"Obadia","year":"1997","journal-title":"Circulation"},{"key":"2021091118365620100_ezab116-B15","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.echo.2016.03.003","article-title":"Abnormalities of the mitral apparatus in hypertrophic cardiomyopathy: echocardiographic, pathophysiologic, and surgical insights","volume":"29","author":"Silbiger","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"2021091118365620100_ezab116-B16","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1053\/j.optechstcvs.2012.04.002","article-title":"Transaortic extended septal myectomy for hypertrophic cardiomyopathy","volume":"17","author":"Schaff","year":"2012","journal-title":"Oper Tech Thorac Cardiovasc Surg"},{"key":"2021091118365620100_ezab116-B17","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1093\/ejcts\/ezt234","article-title":"Predicting systolic anterior motion after mitral valve reconstruction: using intraoperative transoesophageal echocardiography to identify those at greatest risk","volume":"45","author":"Varghese","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118365620100_ezab116-B18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1161\/CIRCULATIONAHA.110.985812","article-title":"Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy","volume":"124","author":"Maron","year":"2011","journal-title":"Circulation"},{"key":"2021091118365620100_ezab116-B19","first-page":"II60","article-title":"Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy","volume":"86","author":"McIntosh","year":"1992","journal-title":"Circulation"},{"key":"2021091118365620100_ezab116-B20","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1016\/j.athoracsur.2012.06.008","article-title":"Role of mitral valve plication in the surgical management of hypertrophic cardiomyopathy","volume":"94","author":"Balaram","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"2021091118365620100_ezab116-B21","doi-asserted-by":"crossref","first-page":"II115","DOI":"10.1161\/01.CIR.0000138580.57971.b4","article-title":"Importance of mitral valve second-order chordae for left ventricular geometry, wall thickening mechanics, and global systolic function","volume":"110","author":"Rodriguez","year":"2004","journal-title":"Circulation"},{"key":"2021091118365620100_ezab116-B22","doi-asserted-by":"crossref","first-page":"II91","DOI":"10.1161\/01.CIR.0000138396.24335.6a","article-title":"Cutting second-order chords does not prevent acute ischemic mitral regurgitation","volume":"110","author":"Rodriguez","year":"2004","journal-title":"Circulation"},{"key":"2021091118365620100_ezab116-B23","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/j.athoracsur.2008.01.061","article-title":"Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes","volume":"85","author":"Kaple","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2021091118365620100_ezab116-B24","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":"Hodges","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021091118365620100_ezab116-B25","doi-asserted-by":"crossref","first-page":"364","DOI":"10.21037\/acs.2017.05.12","article-title":"Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience","volume":"6","author":"Vanderlaan","year":"2017","journal-title":"Ann Cardiothorac Surg"},{"key":"2021091118365620100_ezab116-B26","first-page":"638","article-title":"Hypertrophic cardiomyopathy: the edge-to-edge secures the correction of the systolic anterior motion","volume":"51","author":"Obadia","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118365620100_ezab116-B27","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1001\/jamacardio.2016.0252","article-title":"Hospital volume outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: US Nationwide Inpatient Database, 2003","volume":"1","author":"Kim","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2021091118365620100_ezab116-B28","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.jcct.2017.07.004","article-title":"Assessment of aortic valve calcium load by multidetector computed tomography. Anatomical validation, impact of scanner settings and incremental diagnostic value","volume":"11","author":"Boulif","year":"2017","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2021091118365620100_ezab116-B29","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.4244\/EIJV11I12A273","article-title":"Computed tomography optimised fluoroscopy guidance for transcatheter mitral therapies","volume":"11","author":"Van Mieghem","year":"2016","journal-title":"EuroIntervention"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/3\/699\/40350267\/ezab116.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/3\/699\/40350267\/ezab116.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,11]],"date-time":"2021-09-11T18:37:26Z","timestamp":1631385446000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/60\/3\/699\/6161229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,6]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,6]]},"published-print":{"date-parts":[[2021,9,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezab116","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2021,3,6]]}}}