title: Role of mitral valve plication in the surgical management of hypertrophic cardiomyopathy.
abstract: BACKGROUND
  We have previously reported our 3-step repair for obstructive hypertrophic cardiomyopathy (HCM) consisting of resection of the septum, horizontal plication of the anterior mitral leaflet (AML), and release of abnormal papillary muscle attachments. This article reviews our complete experience with surgical management of HCM to better understand the role and relevance of mitral plication.
  
  
  METHODS
  From 1997 to 2011, 132 patients with HCM underwent surgical treatment at our institution. Eighty-two patients (62%) received AML plication based on selection criteria and were classified as group A; patients in group B did not receive plication. All patients underwent preoperative and postoperative echocardiography. Long-term clinical follow-up was obtained by review of scheduled echocardiograms and direct patient interview.
  
  
  RESULTS
  The average age of all patients was 55.5 years. Operative mortality was 0%. The mean left ventricular outflow tract (LVOT) gradient decreased from 118±41 mm Hg to 6±13 mm Hg (p<0.0001). Mean mitral regurgitation improved from 2.4±1.0 to 0.5±0.7 (p<0.0001). Postoperatively, 96.2% of patients had no residual systolic anterior motion (SAM). Significant improvements in heart failure classification and quality of life scores were noted for all patients. Comparison of groups A and B showed no statistically significant differences in outcomes, complications, or survival. Survival at 1, 5, and 10 years was 98%, 98%, and 92%, respectively.
  
  
  CONCLUSIONS
  The heterogeneity of the pathologic process in HCM supports detailed analysis of the septum, mitral leaflets, and subvalvular apparatus. Surgical management of HCM that includes horizontal plication of a lax and elongated AML is safe and results in durable clinical and echocardiographic improvement.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA. sbalaram@chpnet.org
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Balaram
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Ross
authors.forename: Mark V
authors.initials: MV
authors.lastname: Sherrid
authors.forename: Gary S
authors.initials: GS
authors.lastname: Schwartz
authors.forename: Zak
authors.initials: Z
authors.lastname: Hillel
authors.forename: Glenda
authors.initials: G
authors.lastname: Winson
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Swistel
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome