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Individualized surgical strategies for left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Richard Collis1, Victor Tsang2, Antonis Pantazis3

  • 1Institute of Cardiovascular Science, University College London, London, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 3, 2018
PubMed

Insights

Surgical septal myectomy effectively treats drug-refractory left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy, significantly reducing gradients and improving symptoms with low mortality.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Hypertrophic Cardiomyopathy Research

Background:

  • Drug-refractory left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) poses significant management challenges.
  • Surgical options include septal myectomy (SM) and mitral valve (MV) interventions.

Purpose of the Study:

  • To report surgical techniques and outcomes for LVOTO in a diverse group of HCM patients.
  • To evaluate the effectiveness of individualized surgical strategies for variable HCM phenotypes.

Main Methods:

  • A consecutive series of 203 patients with LVOTO underwent surgery.
  • Surgical approaches included SM, SM with MV repair/replacement, and MV replacement alone, tailored to obstruction mechanism.
  • Prior alcohol septal ablation was present in 11 patients; 22 had concomitant non-MV procedures.

Main Results:

  • Operative survival was 99.0%. Mean LVOTO gradient decreased from 70.6 mmHg to 11.0 mmHg at 1 year (P < 0.001).
  • New York Heart Association class improved from 2.6 to 1.6 at 1 year.
  • Complications included rare instances of VSD, Gerbode defect, AV block requiring pacemaker, and stroke.

Conclusions:

  • Individualized surgical approaches effectively reduce LVOTO gradients in HCM.
  • These strategies offer good symptomatic relief with acceptable perioperative mortality and morbidity.
  • Tailored surgical management is crucial for diverse LVOTO phenotypes in hypertrophic cardiomyopathy.
Abstract

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