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Concomitant Cox-Maze IV and Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy
Nadia H Bakir1, Robert M MacGregor1, Ali J Khiabani1
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri.
The Annals of Thoracic Surgery
|March 4, 2021
Summary
Concomitant Cox-Maze IV ablation with septal myectomy effectively treats atrial fibrillation in hypertrophic obstructive cardiomyopathy patients, showing excellent long-term freedom from arrhythmias and reduced stroke risk.
Area of Science:
- Cardiovascular Surgery
- Electrophysiology
- Cardiac Surgery
Background:
- Atrial fibrillation (AF) in hypertrophic obstructive cardiomyopathy (HOCM) is linked to heart failure and mortality.
- The efficacy of surgical ablation in HOCM patients with AF is not well-established.
Purpose of the Study:
- To assess the effectiveness of the Cox-Maze IV procedure performed concurrently with septal myectomy in HOCM patients.
- To evaluate freedom from atrial tachyarrhythmias (ATAs) and associated clinical outcomes.
Main Methods:
- Retrospective review of 42 HOCM patients undergoing concomitant septal myectomy and Cox-Maze IV between 2005-2019.
- Annual evaluation of freedom from ATAs (on or off antiarrhythmic drugs).
- Fine-Gray regression analysis to identify predictors of ATA recurrence, with death as a competing risk.
Main Results:
- Excellent 1- and 5-year freedom from ATAs rates of 93% and 100%, respectively.
- High freedom from ATAs and antiarrhythmic drugs (83% at 1 year, 100% at 5 years).
- Concomitant procedure reduced cerebrovascular accident risk compared to myectomy alone.
Conclusions:
- Concomitant Cox-Maze IV and septal myectomy offers excellent long-term ATA control in selected HOCM patients.
- Despite potential perioperative complications, this combined approach should be considered for HOCM patients with AF.
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