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Clinical features and postoperative outcomes in elderly patients undergoing septal myectomy for hypertrophic

Tedy Sawma1, Hartzell V Schaff1, Fernando Juarez-Casso1

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.

The Journal of Thoracic and Cardiovascular Surgery
|October 10, 2024
PubMed

Insights

Septal myectomy is a safe procedure for older adults with obstructive hypertrophic cardiomyopathy, showing improved quality of life. However, left ventricular wall asymmetry indicates a poorer prognosis in this age group.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Obstructive hypertrophic cardiomyopathy (HCM) is often undertreated in older adults due to perceived surgical risks.
  • Septal reduction therapies aim to alleviate symptoms and improve outcomes in HCM patients.
  • Understanding age-related differences in HCM presentation and surgical outcomes is crucial for clinical decision-making.

Purpose of the Study:

  • To compare clinical and echocardiographic characteristics between younger and older patients undergoing septal myectomy for obstructive HCM.
  • To assess early and late postoperative outcomes in different age groups undergoing septal myectomy.
  • To evaluate the safety and efficacy of septal myectomy in elderly patients with obstructive HCM.

Main Methods:

  • A retrospective analysis of 2663 patients who underwent transaortic septal myectomy between 2000 and 2021.
  • Patients were categorized into three age groups: 18-64 years, 65-74 years, and 75 years or older.
  • Clinical data, echocardiographic findings, and postoperative outcomes were analyzed and compared across age groups.

Main Results:

  • Older patients exhibited distinct characteristics, including higher prevalence of female sex, hypertension, and diabetes, but similar functional limitations.
  • Elderly patients had thinner walls and less septal asymmetry, with a trend towards higher hospital mortality (1.3% in ≥75 years) and lower 5-year survival (91% in ≥75 years).
  • Septal-to-posterior wall thickness ratio correlated with increased mortality in older adults (≥65 years), while most patients reported improved quality of life post-surgery.

Conclusions:

  • Obstructive hypertrophic cardiomyopathy presents differently in older adults, with distinct clinical and morphological variants.
  • Septal myectomy is a safe and effective treatment option for elderly patients with obstructive HCM, improving quality of life.
  • Left ventricular wall asymmetry is a significant predictor of poorer prognosis in older patients undergoing septal myectomy.
Abstract

Keywords:
ageasymmetric hypertrophyelderlyhypertrophic cardiomyopathyseptal myectomy

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