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[Hypertrophic obstructive cardiomyopathy: surgical therapy]
H D Schulte1, W Bircks, B Lösse
1Abteilung für Thorax- und Kardiovaskuläre Chirurgie, Universität Düsseldorf.
Insights
Surgical myectomy for hypertrophic obstructive cardiomyopathy (HOCM) offers improved outcomes. This surgery is recommended for symptomatic HOCM patients unresponsive to drug therapy, demonstrating reduced mortality and enhanced physical performance post-operation.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Medical Treatment
Context:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a condition requiring intervention when drug therapy fails.
- Surgical treatment, specifically transaortic subvalvular myectomy (TSM), has been utilized for decades.
- Patients often present with severe symptoms (NYHA class III or IV).
Purpose:
- To report outcomes of surgical myectomy in a large cohort of HOCM patients.
- To evaluate the safety and efficacy of transaortic subvalvular myectomy (TSM).
- To assess long-term survival and symptom improvement after surgery.
Summary:
- A retrospective analysis of 353 HOCM patients undergoing transaortic subvalvular myectomy (TSM) between 1963 and 1991.
- Overall hospital mortality was 4.8%, with lower rates for TSM alone (3.1%) compared to combination surgery (9.8%).
- Recent data (since 1984) show improved mortality rates (2.06%), with long-term follow-up indicating better symptoms, physical performance, and lower annual mortality (1.1%) compared to drug-treated patients (1.8-4%).
Impact:
- Surgical myectomy is a viable and recommended option for symptomatic HOCM patients refractory to medical management.
- The procedure leads to significant improvements in patient quality of life and physical capacity.
- Refined surgical techniques have progressively reduced operative mortality, enhancing the procedure's overall benefit-risk profile.
Abstract:
Surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM), which may present in a typical (subaortic) or atypical (mid-ventricular) form, is indicated only after prior long-term drug treatment. The results obtained in 353 patients presenting with a symptomatic form of HOCM operated on between 1963 and 30 June 1991 are reported. The operative procedure took the form of transaortic subvalvular myectomy (TSM) as described by Morrow, modified by extending the myectomy. The patients comprised 210 males and 143 females aged between 6 and 76 years (average age 41.7 years). With few exceptions, all patients were in clinical stage III or IV (NYHA). The overall hospital mortality rate was 4.8% (n = 17); for TSM alone 3.1% (n = 8 out of 261 patients), for combination surgery with additional surgical measures 9.8% (n = 9 out of 92 patients). Among the last 194 patients (since 1984), the mortality rate was 2.06% (n = 4). To date, follow-up show an improvement in the symptoms and physical performance, and an annual mortality rate of about 1.8-4% among patients treated with drugs, and a post-operative mortality of about 1.1%, so that in HOCM patients with symptoms despite prior drug treatment, surgery can be recommended.