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Published on: June 20, 2018
Early and midterm results of extended septal myectomy: Indian experience
Narendra Kumar1, Sharmil Kanna1, Himanshu Goel1
1Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Insights
Extended septal myectomy (ESM) effectively treats hypertrophic obstructive cardiomyopathy (HOCM) by reducing left ventricular outflow tract obstruction. This procedure provides significant midterm symptom relief and improves cardiac function in HOCM patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Genetics
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic heart condition leading to significant morbidity and sudden cardiac death.
- Left ventricular outflow tract obstruction (LVOTO) is a primary complication of HOCM, causing severe symptoms.
- Extended septal myectomy (ESM) is the established surgical treatment for HOCM-induced LVOTO.
Purpose of the Study:
- To evaluate the midterm impact of ESM on symptom relief in Indian HOCM patients.
- To assess the effectiveness of ESM in reducing LVOTO and improving survival rates.
- To analyze changes in left ventricular pressure and cardiac function post-ESM.
Main Methods:
- Retrospective analysis of 36 symptomatic HOCM patients undergoing ESM from 2010-2019.
- Preoperative and postoperative transthoracic echocardiography to measure LVOT gradient and septal thickness.
- Assessment of valvar and cardiac function, alongside NYHA functional class and survival data.
Main Results:
- Successful ESM in all patients, with a significant reduction in mean LVOT gradient (113 to 15 mmHg, p<0.0001).
- Mean septal thickness decreased from 23.89 mm to 13.17 mm (p<0.0001).
- NYHA functional class improved from III-IV to I (p<0.0001) at a mean 2-year follow-up, with 5.6% in-hospital mortality and no further deaths.
Conclusions:
- ESM effectively abolishes mechanical LVOTO, normalizing left ventricular pressure.
- The procedure leads to immediate and sustained symptom elimination in HOCM patients.
- ESM is a safe and effective treatment for HOCM, offering significant midterm benefits.
Background And Objectives:
Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder, which is a cause of significant morbidity and sudden cardiac death. Extended septal myectomy (ESM) is the therapeutic gold standard to treat left ventricular outflow tract obstruction (LVOTO) in HOCM resulting in long-term symptomatic relief. The aim of the study was to assess the impact of ESM on midterm symptom relief, LVOTO, and survival in patients suffering from HOCM in the Indian population.
Methods:
We retrospectively analyzed clinical data of 36 consecutive symptomatic patients with HOCM having symptoms refractory to medical treatment and LVOTO with resting gradient ≥ 50 mmHg and who underwent ESM at our institution from 2010 to 2019. Preoperative and postoperative transthoracic echocardiography was performed to assess left ventricular outflow tract (LVOT) gradient, septal thickness, and assessment of valvar and cardiac function.
Results:
ESM was performed successfully in all 36 patients. The mean preoperative LVOT gradient was 113.06 ± 36.70 mmHg and decreased to 15.17 ± 7.30 mmHg (p < .0001) in the initial postoperative period. There were two in-hospital deaths (5.6%). There was no further mortality in the subsequent follow-up. The mean septal thickness was 23.89 ± 5.77 mm preoperatively and 13.17 ± 3.48 mm (p < .0001) postoperatively. During a mean follow-up of 2 years, the NYHA functional class improved from 3.50 ± 0.70 (III-IV) to 1.50 ± 0.70 (I) (p < .0001).
Conclusions:
ESM results in immediate abolition of mechanical obstruction to LVOT with normalization of left ventricular pressure and eliminates symptoms associated with HOCM.
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