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Reoperation for persistent outflow obstruction in hypertrophic cardiomyopathy
C S Roberts1, C L McIntosh, P S Brown
1Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
The Annals of Thoracic Surgery
|March 11, 1991
Summary
Reoperative myotomy and myectomy (M + M) offers similar survival to mitral valve replacement (MVR) for hypertrophic cardiomyopathy. However, M + M results in a higher provoked left ventricular outflow gradient post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Hypertrophic Cardiomyopathy
Background:
- Persistent left ventricular outflow obstruction after initial myotomy and myectomy (M+M) necessitates reoperation.
- Mitral valve replacement (MVR) is an alternative reoperative strategy.
Purpose of the Study:
- To compare the outcomes of a second M+M versus MVR for reoperative treatment of left ventricular outflow obstruction.
- To evaluate functional class, hemodynamic parameters, and survival rates.
Main Methods:
- Retrospective comparison of two groups: second M+M (n=12) and MVR (n=11).
- Analysis of patient demographics, pre- and post-operative functional class, cardiac index, left ventricular outflow gradients, and survival.
- Follow-up averaged 5.9 years for M+M and 3.4 years for MVR.
Main Results:
- Both groups showed similar improvements in functional class, cardiac index, and resting outflow gradients.
- The second M+M group had a significantly higher provoked outflow gradient (57 vs. 14 mm Hg, p<0.05).
- Actuarial survival at 3 and 5 years was comparable between the second M+M (83%, 76%) and MVR (92%, 77%) groups.
Conclusions:
- A second M+M and MVR provide similar long-term survival for patients with hypertrophic cardiomyopathy and persistent left ventricular outflow obstruction.
- Second M+M may be less effective in controlling provoked left ventricular outflow gradients compared to MVR.