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Long-term follow-up of patients undergoing myotomy/myectomy for obstructive hypertrophic cardiomyopathy
L H Cohn1, H Trehan, J J Collins
1Department of Surgery, Harvard Medical School, Boston, Massachusetts.
Insights
Radical septal myotomy/myectomy significantly reduced obstructive hypertrophic cardiomyopathy symptoms and pressure gradients. Long-term survival was favorable, with no reoperations needed for subaortic obstruction.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Cardiac Surgery
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) presents significant challenges in managing congestive heart failure.
- Surgical intervention via myotomy/myectomy aims to alleviate left ventricular outflow tract obstruction.
Purpose of the Study:
- To evaluate the long-term outcomes of radical septal myotomy/myectomy in patients with obstructive hypertrophic cardiomyopathy.
- To assess the impact of the procedure on functional class, pressure gradients, and survival rates.
Main Methods:
- Retrospective analysis of 31 patients (mean age 55) with New York Heart Association functional class III-IV HCM.
- Underwent radical myotomy/myectomy between 1972 and 1991.
- Preoperative and postoperative assessment included catheterization/echocardiography and clinical evaluation.
Main Results:
- No operative deaths; 2 patients experienced early complete heart block requiring pacemakers.
- Significant reduction in mean pressure gradients from 96 mm Hg to 4.5 mm Hg (p < 0.001).
- Mean postoperative functional class improved to II; 10-year survival was 86% +/- 9%.
Conclusions:
- Radical septal myotomy/myectomy is an effective treatment for obstructive hypertrophic cardiomyopathy, leading to significant symptom improvement and reduced obstruction.
- The procedure offers favorable long-term survival, with no need for reoperation for residual subaortic obstruction.
- Concomitant coronary artery disease may impact late survival outcomes.
Abstract:
The long-term results of patients undergoing myotomy/myectomy of the ventricular septum for obstructive hypertrophic cardiomyopathy are documented in 31 patients (15 women, 16 men, age range 21 to 80 years [mean 55]) with mean New York Heart Association functional class III to IV congestive heart failure, who underwent radical myotomy/myectomy at the Brigham and Women's Hospital from 1972 to 1991. Preoperative gradients by catheterization or echocardiography ranged from 26 to 240 mm Hg (average 96). There were no operative deaths. Two patients developed early postoperative complete heart block requiring a transvenous pacemaker. Clinical follow-up was 1 to 14 years (mean 6.5). All surviving patients were restudied by echocardiography and clinical examination. The mean postoperative functional class was II. Postoperative gradients ranged from 0 to 30 mm Hg (mean 4.5) (p less than 0.001 compared with preoperative values). There were 5 late deaths (low cardiac output in 2, stroke in 2, and acute respiratory failure in 1); 4 of 5 deaths occurred in patients with concomitant coronary artery disease. Survival at 10 years was 86 +/- 9%. There were no reoperations for subaortic obstruction.