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Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy
07:02

Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy

Published on: September 9, 2020

Management strategy in 249 consecutive patients with obstructive hypertrophic cardiomyopathy referred to a dedicated

Richard D Rothman1, Aaron L Baggish, Caitlin O'Callaghan

  • 1Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, USA. rrothman@partners.org

The American Journal of Cardiology
|July 7, 2012
PubMed

Insights

Conservative management successfully resolves symptoms in over a third of obstructive hypertrophic cardiomyopathy patients, avoiding the need for septal reduction therapy. Key predictors of failure include advanced New York Heart Association class and increased septal wall thickness.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Obstructive hypertrophic cardiomyopathy (HC) management often involves septal reduction therapy (SRT).
  • The success rates and failure predictors of conservative management for obstructive HC are not well-established.

Purpose of the Study:

  • To evaluate the efficacy of conservative management strategies for symptomatic obstructive HC.
  • To identify predictors of failed conservative therapy in patients with obstructive HC.

Main Methods:

  • A cohort of 249 symptomatic obstructive HC patients were analyzed.
  • Follow-up assessed symptom resolution with optimized medical therapy (beta-blockers, calcium channel blockers, disopyramide) and pacing.
  • Multivariate analysis identified predictors of conservative therapy failure.

Main Results:

  • Conservative therapy successfully resolved symptoms in over one-third of patients over a 3.7-year follow-up.
  • New York Heart Association class III/IV symptoms and greater septal wall thickness predicted conservative therapy failure.
  • 60% of patients not requiring immediate SRT were free from SRT recommendation at follow-up.

Conclusions:

  • Optimized conservative therapy is effective in managing symptoms for a significant portion of obstructive HC patients, potentially obviating the need for SRT.
  • Clinicians should prioritize optimizing conservative medical management before considering SRT for obstructive HC.

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