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Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy

Dominic J Parry1, Robert E Raskin1, Jeffery A Poynter2

  • 1Department of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

The Annals of Thoracic Surgery
|February 14, 2015
PubMed

Insights

Septal myectomy (SM) for hypertrophic obstructive cardiomyopathy (HOCM) significantly improves symptoms and reduces outflow tract gradients. This surgery offers excellent long-term outcomes with minimal operative risk for HOCM patients.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Medical Research

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is a condition requiring surgical intervention.
  • Septal myectomy (SM) is a primary surgical treatment for HOCM.
  • Adjunctive procedures, including aortic shortening, may be used in HOCM surgery.

Purpose of the Study:

  • To report a single surgeon's 10-year experience with corrective surgery for HOCM.
  • To evaluate factors influencing long-term outcomes after HOCM surgery.
  • To describe the technique of septal myectomy and aortic shortening in HOCM patients.

Main Methods:

  • Retrospective review of institutional surgical databases from 2001-2011.
  • Analysis of perioperative data for 211 patients undergoing septal myectomy for HOCM.
  • Follow-up included echocardiogram review and telephone interviews for clinical status.

Main Results:

  • Significant improvement in New York Heart Association (NYHA) class and Canadian Cardiovascular Society (CCS) angina grade post-surgery.
  • Marked reduction in left ventricular outflow tract gradient, right ventricular systolic pressure, and mitral regurgitation.
  • Low in-hospital mortality (0.5%) and high survival rates (98.6% at 1 year, 98.1% at 5 years).
  • Predictors of worse outcomes included preoperative NYHA/CCS class, new-onset atrial fibrillation, and female sex.

Conclusions:

  • Septal myectomy provides excellent symptom relief for patients with obstructive HOCM.
  • The surgical procedure is associated with minimal operative risk.
  • Long-term outcomes are favorable, with significant functional improvement and survival.
Abstract

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