{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T07:59:33Z","timestamp":1764403173660,"version":"3.41.2"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of this study was to assess the impact of septal thickness on long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) and correction of mitral subvalvular anomalies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixty-six consecutive patients (58 \u00b1 12 years, 56% female) undergoing extended septal myectomy and subvalvular mitral apparatus remodeling from 2007 to 2021 were retrospectively reviewed. Patients were divided into 2 groups according to septal thickness: moderate [&amp;lt; 18 mm, 29 patients (44%)] and severe [\u2265 18 mm, 37 patients (56%)]. End points included survival, symptom improvement, reduction of left ventricle outflow tract (LVOT) gradient, resolution of mitral regurgitation (MR), and reoperation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean interventricular septal thickness was 19 \u00b1 3 mm, 15.8 \u00b1 0.8 mm in patients with moderate and 21.4 \u00b1 3.2 mm in those with severe hypertrophy. Preoperative data, intraoperative variables, postoperative complication rates, pre-discharge echocardiographic and clinical parameters did not differ between the two study groups [except for procedures involving the posterior mitral leaflet (<jats:italic>p<\/jats:italic> = 0.033) and septal thickness after myectomy (<jats:italic>p<\/jats:italic> = 0.0001)]. Subvalvular apparatus remodeling (secondary chordae of mitral valve resection and papillary muscle and muscularis trabecula procedures including resection, splitting, and elongation) was invariably added to septal myectomy (100%). Four (6%) procedures involved the posterior mitral leaflets. Mitral valve replacement was carried out in two patients (3%, <jats:italic>p<\/jats:italic> = 0.4). Reoperation for persistent MR was necessary in one patient (1%, <jats:italic>p<\/jats:italic> = 0.4). Neither iatrogenic ventricular septal defect nor in-hospital mortality occurred. During follow-up (mean 4.8 \u00b1 3.8 years), two deaths occurred. NYHA class was reduced from 2.9 \u00b1 0.7 to 1.6 \u00b1 0.6 (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001), the LVOT gradient from 89.7 \u00b1 34.5 to 16.3 \u00b1 8.8 mmHg (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001), mitral valve regurgitation grade from 2.5 \u00b1 1 to 1.2 \u00b1 0.5 (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001), and septal thickness from 18.9 \u00b1 3.7 to 13.9 \u00b1 2.7 mm (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Regardless of septal thickness, subvalvular apparatus remodeling with concomitant septal myectomy can provide satisfactory long-term outcomes in terms of symptom improvement, LVOT obstruction relief, and MR resolution (without mitral valve replacement in most cases) in patients with HOCM.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.853582","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T04:46:50Z","timestamp":1655268410000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Septal Thickness Does Not Impact Outcome After Hypertrophic Obstructive Cardiomyopathy Surgery (Septal Myectomy and Subvalvular Mitral Apparatus Remodeling): A 15-Years of Experience"],"prefix":"10.3389","volume":"9","author":[{"given":"Giuseppe M.","family":"Raffa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eluisa 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