Modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy: A single-center retrospective study in 318 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jie ^1,2 , WENG Fan ² , CHEN Nan ² , SUN Yongxin ² ,  GUO Changfa ² , WANG Chunsheng ² , LIN Yi ² , DING Wenjun ²

1. Department of Cardiovascular Surgery, Huai'an Hospital Affiliated of Yangzhou University, Huai'an Fifth People's Hospital, Huai'an, 223300, Jiangsu, P. R. China;
2. Department of Cardiovascular Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200000, P. R. China;

Corresponding?author：

GUO Changfa, Email: guo.changfa@zs-hospital.sh.cn

Keywords：

Hypertrophic obstructive cardiomyopathy; modified Morrow procedure; systolic anterior motion; Ⅲ° atrioventricular block; left ventricular outflow tract obstruction; septal myectomy

DOI：

10.7507/1007-4848.202401018

Video：

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Objective To summarize the clinical efficacy of modified Morrow surgery in the treatment of hypertrophic obstructive cardiomyopathy. Methods A retrospective analysis was conducted on the clinical data of patients with hypertrophic obstructive cardiomyopathy treated with modified Morrow surgery at Zhongshan Hospital Affiliated to Fudan University from 2020 to 2023. Results A total of 318 patients were enrolled, including 156 males and 162 females, with an average age of (55.6±13.1) years. Preoperative echocardiography showed a mean interventricular septal thickness of (18.1±3.8) mm, peak left ventricular outflow tract pressure difference of (86.4±24.9) mm Hg. The surgery time was (162.3±51.0) min, extracorporeal circulation time was (80.9±31.0) min, and aortic occlusion time was (44.8±20.8) min. After the surgery, transesophageal echocardiography showed that the interventricular septal thickness was (11.0±1.8) mm and left ventricular outflow tract peak pressure difference was (9.4±5.1) mm Hg. The incidence rate of postoperative complete left bundle branch block was 45.3%, Ⅲ° atrioventricular block was 3.8%, and postoperative newly developed atrial fibrillation was 3.1%. The postoperative hospital stay was (6.6±4.9) days, and one perioperative death occurred, with a mortality rate of 0.3%. The follow-up time was (10.3±9.4) months, during which the transthoracic echocardiography revealed a ventricular septal thickness of (12.9±2.9) mm and a peak left ventricular outflow tract pressure difference of (13.9±10.0) mm Hg. Conclusion The modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy is safe and effective, with good results in the short and medium term.

Citation： LI Jie, WENG Fan, CHEN Nan, SUN Yongxin, GUO Changfa, WANG Chunsheng, LIN Yi, DING Wenjun. Modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy: A single-center retrospective study in 318 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(3): 431-437. doi: 10.7507/1007-4848.202401018 Copy

1.	Nishimura RA, Seggewiss H, Schaff HV. Hypertrophic obstructive cardiomyopathy: surgical myectomy and septal ablation. Circ Res, 2017, 121(7): 771-783.
2.	Nishimura RA, Ommen SR. Hypertrophic cardiomyopathy: the first 200 years. JACC Adv, 2023, 2(9): 100649.
3.	Canepa M, Olivotto I. Evolving epidemiology of hypertrophic cardiomyopathy: shifting the focus from instant to lifetime risk awareness. Circ Heart Fail, 2022, 15(9): e9873.
4.	Ommen SR, Ho CY, Asif IM, et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2024, 149(23): e1239-e1311.
5.	Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation, 2024, 149(3): e10-e23.
6.	Maron BJ, Dearani JA, Smedira NG, et al. Ventricular septal myectomy for obstructive hypertrophic cardiomyopathy (analysis spanning 60 years of practice): AJC expert panel. Am J Cardiol, 2022, 180: 124-139.
7.	Sanghvi MM, Dhall E, Anwar A, et al. Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes, 2025, 11(7): 919-933.
8.	Crean AM, Adler A, Arbour L, et al. Canadian Cardiovascular Society clinical practice update on contemporary management of the patient with hypertrophic cardiomyopathy. Can J Cardiol, 2024, 40(9): 1503-1523.
9.	Sedehi D, Finocchiaro G, Tibayan Y, et al. Contemporary outcomes of surgery for hypertrophic cardiomyopathy in the United States: an analysis of the Society of Thoracic Surgeons database. Ann Thorac Surg, 2024, 117(1): 123-130.
10.	Rader F, Swistel DG, Sherrid MV. Intraoperative echocardiography in hypertrophic cardiomyopathy myectomy: a comprehensive review. J Am Soc Echocardiogr, 2023, 36(4): 367-378.
11.	國家心血管病中心心肌病專科聯盟, 中國醫療保健國際交流促進會心血管病精準醫學分會"中國成人肥厚型心肌病診斷與治療指南2023"專家組. 中國成人肥厚型心肌病診斷與治療指南2023. 中國循環雜志, 2023, 38(1): 1-33.The Joint Committee of Cardiomyopathy Specialty Alliance, National Center for Cardiovascular Diseases/Cardiovascular Precision Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care. 2023 Guideline for Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy. Chin Circ J, 2023, 38(1): 1-33.
12.	Kwon DH, Smedira NG, Thamilarasan M, et al. Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy and minimal outflow obstruction. J Am Coll Cardiol, 2022, 80(10): 1045-1055.
13.	孫杰軍, 何繼強. 肥厚型梗阻性心肌病的治療研究進展. 心肺血管病雜志, 2023, 42(6): 628-632.Sun JJ, He JQ. Research progress in the treatment of hypertrophic obstructive cardiomyopathy. J Cardiovasc Pulm Dis, 2023, 42(6): 628-632.
14.	鄭寧寧, 付永兵, 薛楓, 等. 梗阻性肥厚型心肌病的治療策略與療效評估. 中華心臟與心律電子雜志, 2025, 13(3): 156-163.Zheng NN, Fu YB, Xue F, et al. Treatment strategies and efficacy evaluation of hypertrophic obstructive cardiomyopathy. Chin J Heart Rhythm, 2025, 13(3): 156-163.
15.	Qamruddin S, Naidu SS. Advances in the interventional and surgical management of hypertrophic cardiomyopathy. Curr Cardiol Rep, 2024, 26(1): 1-11.
16.	魏翔. 肥厚型梗阻性心肌病外科治療進展. 臨床外科雜志, 2023, 31(9): 801-803.Wei X. Progress in surgical treatment of hypertrophic obstructive cardiomyopathy. J Clin Surg, 2023, 31(9): 801-803.
17.	Weissler-Snir A, Adler A, Rakowski H. MV surgery as adjunct to surgical myectomy for obstructive HCM: less is more than enough. J Am Coll Cardiol, 2016, 66(14): 1505-1508.
18.	Desai MY, Owens AT, Geske JB, et al. Myectomy for obstructive hypertrophic cardiomyopathy: the Mayo Clinic 50-year experience. JACC Cardiovasc Interv, 2023, 16(2): 235-247.
19.	劉方鈺, 季強, 王毓琳, 等. 梗阻性肥厚型心肌病的外科治療: 單中心5年421例經驗總結. 中華外科雜志, 2023, 61(3): 201-208.Liu FY, Ji Q, Wang YL, et al. Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases. Chin J Surg, 2023, 61(3): 201-208.
20.	Nguyen A, Schaff HV, Nishimura RA, et al. Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy. Eur J Cardiothorac Surg, 2018, 53(3): 582-589.
21.	Hodges K, Rivas CG, Aguilera J, et al. Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center. J Thorac Cardiovasc Surg, 2019, 157(6): 2289-2299.
22.	Malcolmson J, Shipolini A, Mohiddin S, et al. The mitral valve in hypertrophic cardiomyopathy. Curr Opin Cardiol, 2023, 38(5): 415-423.
23.	Hong JH, Schaff HV, Nishimura RA, et al. Papillary muscle manipulation versus extended myectomy alone for hypertrophic obstructive cardiomyopathy. Eur J Cardiothorac Surg, 2023, 63(4): ezad042.
24.	Wei P, Liu J, Ma J, et al. Thoracoscopic trans-mitral septal myectomy for hypertrophic obstructive cardiomyopathy in the elderly. Front Cardiovasc Med, 2022, 9: 827860.
25.	Rowin EJ, Maron BJ, Maron MS. The surgical myectomy operative note in hypertrophic cardiomyopathy: defining the essentials. J Thorac Cardiovasc Surg, 2023, 166(5): e215-e227.
26.	Ji Q, Wang YL, Yang Y, et al. Mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: a single-center experience with 168 cases. J Cardiothorac Surg, 2021, 16(1): 25.
27.	蒙延海, 劉平, 張燕博, 等. 肥厚型梗阻性心肌病改良擴大Morrow術后新發心房顫動的危險因素分析及術前腎小球濾過率的預測價值. 中國胸心血管外科臨床雜志, 2021, 28(10): 1234-1241.Meng YH, Liu P, Zhang YB, et al. Risk factors and predictive value of estimated glomerular filtration rate for new-onset atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy after modified extended Morrow procedure. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(10): 1234-1241.
28.	蒙延海, 王水云, 張燕博, 等. 外科治療肥厚型梗阻性心肌病合并冠心病的處理策略及早中期結果. 中國胸心血管外科臨床雜志, 2019, 26(2): 142-147.Meng YH, Wang SY, Zhang YB, et al. Treatment strategies and early- to mid-term outcomes for surgical treatment of hypertrophic obstructive cardiomyopathy combined with coronary artery disease. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(2): 142-147.
29.	蒙延海, 王水云, 張燕博, 等. 外科治療肥厚型心肌病合并心肌橋的臨床結果分析. 中國循環雜志, 2018, 33(8): 37-38.Meng YH, Wang SY, Zhang YB, et al. Result of surgical treatment of hypertrophic obstructive cardiomyopathy with coronary heart disease. Chin Circ J, 2018, 33(8): 37-38.
30.	Nguyen A, Schaff HV. Management of patients with hypertrophic cardiomyopathy and concomitant coronary artery disease. J Thorac Cardiovasc Surg Tech, 2024, 25: 100416.
31.	Mascherbauer J, Maurer G, Rosenhek R, et al. Long-term outcome after myectomy for hypertrophic obstructive cardiomyopathy: a European multicentre study. Eur Heart J, 2023, 44(Suppl 2): ehad655.1157.
32.	Hodges K, Rivas CG, Aguilera J, et al. Late outcomes of patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction after surgical myectomy. J Card Surg, 2023, 38(5): 1210-1218.

1. Nishimura RA, Seggewiss H, Schaff HV. Hypertrophic obstructive cardiomyopathy: surgical myectomy and septal ablation. Circ Res, 2017, 121(7): 771-783.
2. Nishimura RA, Ommen SR. Hypertrophic cardiomyopathy: the first 200 years. JACC Adv, 2023, 2(9): 100649.
3. Canepa M, Olivotto I. Evolving epidemiology of hypertrophic cardiomyopathy: shifting the focus from instant to lifetime risk awareness. Circ Heart Fail, 2022, 15(9): e9873.
4. Ommen SR, Ho CY, Asif IM, et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2024, 149(23): e1239-e1311.
5. Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation, 2024, 149(3): e10-e23.
6. Maron BJ, Dearani JA, Smedira NG, et al. Ventricular septal myectomy for obstructive hypertrophic cardiomyopathy (analysis spanning 60 years of practice): AJC expert panel. Am J Cardiol, 2022, 180: 124-139.
7. Sanghvi MM, Dhall E, Anwar A, et al. Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes, 2025, 11(7): 919-933.
8. Crean AM, Adler A, Arbour L, et al. Canadian Cardiovascular Society clinical practice update on contemporary management of the patient with hypertrophic cardiomyopathy. Can J Cardiol, 2024, 40(9): 1503-1523.
9. Sedehi D, Finocchiaro G, Tibayan Y, et al. Contemporary outcomes of surgery for hypertrophic cardiomyopathy in the United States: an analysis of the Society of Thoracic Surgeons database. Ann Thorac Surg, 2024, 117(1): 123-130.
10. Rader F, Swistel DG, Sherrid MV. Intraoperative echocardiography in hypertrophic cardiomyopathy myectomy: a comprehensive review. J Am Soc Echocardiogr, 2023, 36(4): 367-378.
11. 國家心血管病中心心肌病專科聯盟, 中國醫療保健國際交流促進會心血管病精準醫學分會"中國成人肥厚型心肌病診斷與治療指南2023"專家組. 中國成人肥厚型心肌病診斷與治療指南2023. 中國循環雜志, 2023, 38(1): 1-33.The Joint Committee of Cardiomyopathy Specialty Alliance, National Center for Cardiovascular Diseases/Cardiovascular Precision Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care. 2023 Guideline for Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy. Chin Circ J, 2023, 38(1): 1-33.
12. Kwon DH, Smedira NG, Thamilarasan M, et al. Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy and minimal outflow obstruction. J Am Coll Cardiol, 2022, 80(10): 1045-1055.
13. 孫杰軍, 何繼強. 肥厚型梗阻性心肌病的治療研究進展. 心肺血管病雜志, 2023, 42(6): 628-632.Sun JJ, He JQ. Research progress in the treatment of hypertrophic obstructive cardiomyopathy. J Cardiovasc Pulm Dis, 2023, 42(6): 628-632.
14. 鄭寧寧, 付永兵, 薛楓, 等. 梗阻性肥厚型心肌病的治療策略與療效評估. 中華心臟與心律電子雜志, 2025, 13(3): 156-163.Zheng NN, Fu YB, Xue F, et al. Treatment strategies and efficacy evaluation of hypertrophic obstructive cardiomyopathy. Chin J Heart Rhythm, 2025, 13(3): 156-163.
15. Qamruddin S, Naidu SS. Advances in the interventional and surgical management of hypertrophic cardiomyopathy. Curr Cardiol Rep, 2024, 26(1): 1-11.
16. 魏翔. 肥厚型梗阻性心肌病外科治療進展. 臨床外科雜志, 2023, 31(9): 801-803.Wei X. Progress in surgical treatment of hypertrophic obstructive cardiomyopathy. J Clin Surg, 2023, 31(9): 801-803.
17. Weissler-Snir A, Adler A, Rakowski H. MV surgery as adjunct to surgical myectomy for obstructive HCM: less is more than enough. J Am Coll Cardiol, 2016, 66(14): 1505-1508.
18. Desai MY, Owens AT, Geske JB, et al. Myectomy for obstructive hypertrophic cardiomyopathy: the Mayo Clinic 50-year experience. JACC Cardiovasc Interv, 2023, 16(2): 235-247.
19. 劉方鈺, 季強, 王毓琳, 等. 梗阻性肥厚型心肌病的外科治療: 單中心5年421例經驗總結. 中華外科雜志, 2023, 61(3): 201-208.Liu FY, Ji Q, Wang YL, et al. Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases. Chin J Surg, 2023, 61(3): 201-208.
20. Nguyen A, Schaff HV, Nishimura RA, et al. Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy. Eur J Cardiothorac Surg, 2018, 53(3): 582-589.
21. Hodges K, Rivas CG, Aguilera J, et al. Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center. J Thorac Cardiovasc Surg, 2019, 157(6): 2289-2299.
22. Malcolmson J, Shipolini A, Mohiddin S, et al. The mitral valve in hypertrophic cardiomyopathy. Curr Opin Cardiol, 2023, 38(5): 415-423.
23. Hong JH, Schaff HV, Nishimura RA, et al. Papillary muscle manipulation versus extended myectomy alone for hypertrophic obstructive cardiomyopathy. Eur J Cardiothorac Surg, 2023, 63(4): ezad042.
24. Wei P, Liu J, Ma J, et al. Thoracoscopic trans-mitral septal myectomy for hypertrophic obstructive cardiomyopathy in the elderly. Front Cardiovasc Med, 2022, 9: 827860.
25. Rowin EJ, Maron BJ, Maron MS. The surgical myectomy operative note in hypertrophic cardiomyopathy: defining the essentials. J Thorac Cardiovasc Surg, 2023, 166(5): e215-e227.
26. Ji Q, Wang YL, Yang Y, et al. Mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: a single-center experience with 168 cases. J Cardiothorac Surg, 2021, 16(1): 25.
27. 蒙延海, 劉平, 張燕博, 等. 肥厚型梗阻性心肌病改良擴大Morrow術后新發心房顫動的危險因素分析及術前腎小球濾過率的預測價值. 中國胸心血管外科臨床雜志, 2021, 28(10): 1234-1241.Meng YH, Liu P, Zhang YB, et al. Risk factors and predictive value of estimated glomerular filtration rate for new-onset atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy after modified extended Morrow procedure. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(10): 1234-1241.
28. 蒙延海, 王水云, 張燕博, 等. 外科治療肥厚型梗阻性心肌病合并冠心病的處理策略及早中期結果. 中國胸心血管外科臨床雜志, 2019, 26(2): 142-147.Meng YH, Wang SY, Zhang YB, et al. Treatment strategies and early- to mid-term outcomes for surgical treatment of hypertrophic obstructive cardiomyopathy combined with coronary artery disease. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(2): 142-147.
29. 蒙延海, 王水云, 張燕博, 等. 外科治療肥厚型心肌病合并心肌橋的臨床結果分析. 中國循環雜志, 2018, 33(8): 37-38.Meng YH, Wang SY, Zhang YB, et al. Result of surgical treatment of hypertrophic obstructive cardiomyopathy with coronary heart disease. Chin Circ J, 2018, 33(8): 37-38.
30. Nguyen A, Schaff HV. Management of patients with hypertrophic cardiomyopathy and concomitant coronary artery disease. J Thorac Cardiovasc Surg Tech, 2024, 25: 100416.
31. Mascherbauer J, Maurer G, Rosenhek R, et al. Long-term outcome after myectomy for hypertrophic obstructive cardiomyopathy: a European multicentre study. Eur Heart J, 2023, 44(Suppl 2): ehad655.1157.
32. Hodges K, Rivas CG, Aguilera J, et al. Late outcomes of patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction after surgical myectomy. J Card Surg, 2023, 38(5): 1210-1218.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified Morrow procedure for the treatment of hypertrophic obstructive cardiomyopathy: A single-center retrospective study in 318 patients

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