Operation for hypertrophic subaortic stenosis in the aged.

Area of Science:

• Cardiovascular Surgery
• Geriatric Cardiology
• Interventional Cardiology

Background:

• Idiopathic hypertrophic subaortic stenosis (IHSS) poses unique challenges in elderly patients.
• Operative palliation effectiveness in this demographic requires detailed hemodynamic and survival analysis.

Purpose of the Study:

• To evaluate the efficacy and outcomes of left ventricular myotomy and myectomy (LVMM) in patients aged 65 and older with IHSS.
• To assess the impact of LVMM on hemodynamic parameters, cardiac conduction, symptoms, functional status, and survival.

Main Methods:

• Retrospective analysis of 52 elderly patients (≥65 years) undergoing LVMM (Morrow procedure), with or without concomitant operations.
• Hemodynamic data, cardiac conduction, symptomatology, functional class (NYHA), and survival were analyzed preoperatively and postoperatively.
• Patients were stratified based on the presence or absence of coronary artery disease (CAD).

Main Results:

• LVMM significantly reduced peak resting left ventricular outflow tract gradients in both groups (with CAD: 65 to 3 mm Hg; without CAD: 95 to 17 mm Hg).
• New conduction abnormalities occurred in 72% of survivors, with 85% experiencing symptom improvement.
• Average New York Heart Association Functional Class improved from 3.2 to 1.9 (p < 0.001).
• Hospital mortality for LVMM alone without CAD was 8%, with 5-year survival of 75%. LVMM with CAD had 27% operative mortality.

Conclusions:

• Operative palliation with LVMM is a worthwhile intervention for elderly patients with IHSS, offering significant hemodynamic and functional benefits.
• While effective, the presence of coronary artery disease increases operative mortality, necessitating careful patient selection and management.
• Long-term survival is encouraging, particularly in the absence of concomitant coronary artery disease.