• Elena Ashikhmina, Hartzell V Schaff, Richard C Daly, John M Stulak, Kevin L Greason, Hector I Michelena, Benish Fatima, Brian D Lahr, and Joseph A Dearani.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minn. Electronic address: ashikhmina.elena@mayo.edu.
• J. Thorac. Cardiovasc. Surg. 2021 Aug 1; 162 (2): 567-577.

ObjectivesThe phenomenon of systolic anterior motion (SAM) of the mitral valve (MV) was discovered 50 years ago, but to date only a few studies have identified risk factors for SAM following mitral repair. There are limited data on the necessity of surgical reintervention on the MV once SAM is discovered by intraoperative transesophageal echocardiography. We sought to identify predictors of SAM in a large cohort of consecutive patients, assess the rate of early reintervention on the MV to address SAM, and follow the progression of SAM postdischarge.MethodsAnalysis of electronically stored echocardiographic exams of adults who underwent MV repair in a recent decade.ResultsFollowing MV repair, the incidence of SAM immediately after cardiopulmonary bypass was 13% (98 of 761 patients). Multivariable analysis revealed several preoperative risk factors of SAM development and progression, including a lower ratio of anterior to posterior leaflets heights, younger age, lower end-systolic left ventricular volume, presence of bileaflet prolapse, and male sex. SAM was managed conservatively in 91 patients (93%) and surgically in 7 patients (7%). In a majority of patients (70 of 98 patients [71%]) SAM resolved before hospital discharge.ConclusionsTransesophageal echocardiography findings associated with SAM were excessive height of posterior to anterior mitral leaflet, smaller left ventricular end-systolic volume, and bileaflet prolapse. Conservative management of SAM was usually successful, and persistent hemodynamically significant SAM was uncommon. Prophylactic modification of the surgical technique to avoid SAM seems unnecessary for all but those at highest risk for developing SAM.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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