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Published on: March 27, 2018
Clinical Outcomes of Concomitant Coronary Artery Bypass Grafting During Ventricular Septal Myectomy
Tao Lu1, Changsheng Zhu1, Hao Cui2
1Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Insights
Concomitant coronary artery bypass grafting during septal myectomy is safe and effective. Patients experience excellent survival rates and improved functional class, comparable to septal myectomy alone.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Hypertrophic Cardiomyopathy Treatment
Background:
- Clinical characteristics and survival outcomes of concomitant coronary artery bypass grafting (CABG) during septal myectomy are not well-established.
- Septal myectomy is a surgical procedure to treat hypertrophic obstructive cardiomyopathy.
- CABG is performed to improve blood flow to the heart muscle.
Purpose of the Study:
- To evaluate the safety and efficacy of performing CABG concurrently with septal myectomy.
- To analyze the causes of concomitant CABG and their impact on patient survival.
- To compare outcomes of combined procedures with septal myectomy alone.
Main Methods:
- Retrospective review of 320 patients who underwent both septal myectomy and CABG between 2009 and 2020.
- Analysis of reasons for CABG (atherosclerotic coronary artery disease vs. myocardial bridging).
- Assessment of postoperative outcomes, including left ventricular outflow gradient, survival rates, and composite endpoints.
Main Results:
- The majority of CABG procedures were for atherosclerotic coronary artery disease (69.7%) or myocardial bridging (28.1%).
- Patients undergoing CABG for coronary artery disease were older, had longer bypass times, and required more grafts (P<0.05).
- Significant reduction in left ventricular outflow gradient (85.4 to 12.8 mm Hg, P<0.001) with no perioperative deaths.
- 5-year survival rates were high (>96%) and comparable to the general myectomy cohort (P>0.05).
- Morbidity was reduced with at least one arterial graft (HR, 0.47; P=0.034).
Conclusions:
- Concomitant CABG during septal myectomy is a safe procedure.
- Patients achieve favorable postoperative outcomes, including >95% 5-year survival and >90% improved functional class.
- Combined surgery offers outcomes comparable to septal myectomy alone.
Background:
The clinical characteristics and survival outcomes of patients who underwent concomitant coronary artery bypass grafting during septal myectomy have not been well studied.
Methods And Results:
We reviewed patients who underwent both septal myectomy and coronary artery bypass grafting from 2009 to 2020. Causes of concomitant grafting and their impact on survival were analyzed. The median follow-up period was 5.1 years. A total of 320 patients underwent both grafting and myectomy. Of these, 69.7% and 28.1% underwent grafting attributed to atherosclerotic coronary artery disease and myocardial bridging, respectively. Patients who underwent grafting for coronary artery disease tended to be older, had a longer bypass time, and required more grafts compared with patients undergoing procedures because of myocardial bridging (all P<0.05). Postoperatively, the left ventricular outflow gradient significantly decreased from 85.4 mm Hg to 12.8 mm Hg (P<0.001) without perioperative death. The cumulative survival rates were 96.2% and 97.6% at 5 years in the coronary artery disease and myocardial bridging groups, respectively, and they were comparable to that of general myectomy cohort (hazard ratio [HR], 1.06 [95% CI, 0.47-2.36], P=0.895 and HR 0.75 [95% CI, 0.23-2.46], P=0.636, respectively). Sudden death accounted for 45.5% (5 of 11) of postoperative mortality. Analysis of composite end point events showed decreased morbidity with at least one arterial graft in the overall cohort (HR, 0.47 [95% CI, 0.23-0.94], P=0.034).
Conclusions:
Concomitant grafting in septal myectomy was found to be a safe procedure. Patients who underwent such surgery experienced favorable postoperative outcomes comparable to those who underwent septal myectomy alone, with a 5-year survival rate of >95% and improved functional class of >90%.
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