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[Effectiveness of Extended Myectomy in Patients With Hypertrophic Cardiomyopathy With Midventricular Obstruction]

A V Bogachev-Prokophiev1, S I Zheleznev1, M S Fomenko1

  • 1Acad. E.N. Meshalkin Novosibirsk State Research Institute of Circulaton Pathology, Novosibirsk, Russia.

Kardiologiia
|August 2, 2017
PubMed

Insights

Extended myectomy is a safe and effective treatment for hypertrophic obstructive cardiomyopathy (HOCM) with midventricular obstruction. This surgical approach significantly reduces left ventricular outflow tract obstruction in HOCM patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) can cause significant left ventricular outflow tract (LVOT) obstruction.
  • Midventricular obstruction is a specific subtype of HOCM requiring tailored surgical approaches.

Purpose of the Study:

  • To evaluate the safety and effectiveness of extended myectomy in patients with HOCM and midventricular obstruction.
  • To assess the impact of extended myectomy on LVOT gradients and patient outcomes.

Main Methods:

  • Retrospective analysis of 32 HOCM patients with midventricular obstruction who underwent extended myectomy between 2010 and 2013.
  • Intraoperative transesophageal echocardiography (TEE) guided surgical procedures.
  • Assessment of pre- and post-operative LVOT gradients and complications.

Main Results:

  • No early deaths were observed in the study cohort.
  • Extended myectomy resulted in a significant reduction of mean peak LVOT gradient from 89.1+/-20.4 mm Hg to 15.4+/-5.7 mm Hg.
  • No major complications specific to extended myectomy were reported; 6.9% of patients required permanent pacemaker implantation due to complete atrioventricular block. Survival at 22 months was 94.2%.

Conclusions:

  • Extended myectomy is a safe and effective surgical option for HOCM patients with midventricular obstruction.
  • The procedure leads to substantial reduction in LVOT obstruction and favorable long-term survival.
  • Individual patient assessment is crucial for considering extended myectomy in HOCM with midventricular obstruction.
Abstract

Keywords:
heart failurehypertrophic cardiomyopathymidventricular obstructionmyectomy

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