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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
PubMed

Insights

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.
Abstract

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