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Midterm results of different treatment methods for myocardial bridging in patients after septal myectomy

Shengwei Wang1, Shuiyun Wang2, Yongqiang Lai1

  • 1Department of Cardiovascular Surgery Center, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Journal of Cardiac Surgery
|December 1, 2020
PubMed

Insights

Treating myocardial bridging (MB) during septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) is safe and beneficial. Myocardial unroofing is recommended for MB, offering better long-term outcomes compared to untreated cases.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Myocardial bridging (MB) is often treated in hypertrophic cardiomyopathy patients.
  • The optimal management of MB in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing septal myectomy is not well-defined.

Purpose of the Study:

  • To evaluate the safety and efficacy of surgical MB treatment during septal myectomy in HOCM patients.
  • To compare outcomes between different MB treatment strategies, including myocardial unroofing and no treatment.

Main Methods:

  • Retrospective study of 823 adult HOCM patients who underwent septal myectomy between 2011 and 2017.
  • Analysis of clinical events, including all-cause death, cardiovascular death, nonfatal myocardial infarction (MI), and combined endpoints.
  • Cox regression analysis to identify predictors of adverse outcomes.

Main Results:

  • While all-cause and cardiovascular death rates were similar across groups, untreated MB was associated with significantly higher rates of nonfatal MI and combined endpoints (p < 0.001 and p = 0.02, respectively).
  • Untreated MB independently predicted combined endpoints (Hazard Ratio: 4.06, p < 0.001).
  • Myocardial unroofing showed no residual MB post-surgery and favorable outcomes.

Conclusions:

  • Surgical treatment for MB during septal myectomy is safe and potentially beneficial for HOCM patients.
  • Myocardial unroofing is the recommended approach for MB in this population, potentially leading to superior long-term results.
Abstract

Keywords:
hypertrophic cardiomyopathymyocardial bridgingseptal myectomy

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