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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
Published on: June 20, 2018
Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation
Qiulan Yang1, Changsheng Zhu1, Hao Cui2
1Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Surgical septal myectomy after alcohol septal ablation for obstructive hypertrophic cardiomyopathy offers satisfactory outcomes, though with a higher risk of atrioventricular block and advanced heart failure. Long-term survival is comparable to primary myectomy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Hypertrophic Cardiomyopathy Research
Background:
- Obstructive hypertrophic cardiomyopathy (OHCM) management can be complex, particularly after failed alcohol septal ablation (ASA).
- Limited data exists on the outcomes of surgical septal myectomy (SSM) in patients with residual obstruction post-ASA.
Purpose of the Study:
- To evaluate the surgical and follow-up outcomes of SSM in patients with OHCM who previously underwent ASA.
- To compare these outcomes with patients who had SSM as their primary intervention.
Main Methods:
- A retrospective analysis of 62 patients with OHCM and residual obstruction post-ASA who underwent SSM.
- Propensity score matching was used to compare these patients with a control group undergoing primary SSM (1:2 ratio).
- Echocardiographic parameters, surgical results, and long-term follow-up data were analyzed.
Main Results:
- The prior ASA group showed a higher incidence of complete atrioventricular block (AVB) and pacemaker implantation (9.7% vs. 1.6%).
- Operative mortality was similar (3.2% vs. 0.8%), and 5-year event-free survival rates were comparable (86.0% vs. 88.5%).
- Patients with prior ASA had an increased risk of progressing to advanced heart failure during follow-up (6.5% vs. 0.8%).
Conclusions:
- SSM in OHCM patients with prior ASA is associated with satisfactory surgical and long-term survival outcomes.
- These patients face an elevated risk of AVB and subsequent pacemaker implantation.
- An increased risk of advanced heart failure progression was observed in the post-ASA SSM group.
Background:
Although surgical treatment of residual obstruction after alcohol septal ablation (ASA) is often challenging in patients with obstructive hypertrophic cardiomyopathy (OHCM) there are very few relevant clinical reports. Thus, outcomes of surgical septal myectomy (SSM) in this subgroup of patients remain to be determined. Therefore, this study aimed to determine the surgical and follow-up outcomes in patients with OHCM exhibiting residual obstruction after ASA.
Methods:
We collected case data for 62 patients with OHCM and residual obstruction after ASA who underwent SSM at Fuwai Hospital between January 2002 and June 2019. Propensity score matching with patients having had a myectomy as the only invasive procedure-was conducted in a 1:2 ratio. Echocardiography parameters, surgery results, and follow-up outcomes were compared between the groups.
Results:
The prior ASA group had a higher incidence of complete atrioventricular block (AVB) and subsequently postoperative permanent pacemaker (PPM) implantation than the primary myectomy group (9.7% vs. 1.6%, P=0.01). Two patients died within 30 days after surgery in the prior ASA group, and one patient died in the primary myectomy group, with an operative mortality rate of 3.2% and 0.8%, respectively (P=0.2). The 5-year event-free survival rate was 86.0% in the prior ASA group (median follow-up period: 3.2 years; mean: 3.9±2.6 years; maximum, 10.6 years) and 88.5% in the primary myectomy group (median follow-up period: 2.4 years; mean 2.8±1.7 years; maximum, 9.1 years) (P=0.2). During follow-up, four of 62 (6.5%) patients in the prior ASA group and one of 124 (0.8%) patients in the primary myectomy group progressed to advanced heart failure (P=0.025).
Conclusions:
Patients with OHCM following ASA are at an increased risk of developing AVB after SSM. Their surgical outcomes, and long-term survival rate were satisfactory and, osimilar to those for patients having had a myectomy as the only invasive procedure. In addition, they had an increased risk of advanced heart failure after SSM in the present study.
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