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Surgical aspects of typical subaortic and atypical midventricular hypertrophic obstructive cardiomyopathy (HOCM)
Insights
Surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) is recommended for symptomatic patients. Surgery significantly reduces late mortality compared to medical therapy for this left ventricular outflow tract obstruction.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents as left ventricular outflow tract obstruction.
- Two primary forms exist: typical subaortic and atypical midventricular HOCM.
Purpose of the Study:
- To evaluate the efficacy and outcomes of surgical intervention for HOCM.
- To compare surgical results with medical management in symptomatic patients.
Main Methods:
- Retrospective analysis of 108 patients with HOCM undergoing surgery.
- Transaortic myectomy was the primary surgical technique.
- Patients were selected based on NYHA class III/IV symptoms and unresponsiveness to medication.
Main Results:
- Overall hospital mortality was 8.3%, with higher rates in atypical HOCM (16.7%).
- Postoperative follow-up showed significantly lower late mortality (2.5%) compared to medical management (10%).
- Transaortic myectomy was effective for both typical and atypical HOCM.
Conclusions:
- Surgical treatment is recommended for symptomatic HOCM patients (NYHA class III/IV).
- Surgery offers superior long-term survival benefits over conservative medical therapy.
- Patients with severe mitral insufficiency represent a challenging surgical group.
Abstract:
Hypertrophic obstructive cardiomyopathy (HOCM) is a special form of left ventricular outflow tract obstruction. Clinical experience demonstrates 2 different types of HOCM of the left ventricle: the typical subaortic or subvalvular HOCM and the atypical midventricular form of myocardial obstruction. In a series of 108 patients operated upon, 96 had typical and 12 had atypical HOCM. Indications for surgical treatment were increase of clinical symptoms to class III or IV (NYHA) and unresponsiveness to drug therapy (beta-blocking agents, calcium-antagonists). The male: female ratio was 21:1. The mean age in the group with typical HOCM was 38.8 years, in the group with atypical HOCM 46.5 years. Transaortic myectomy (n = 85) was the predominant surgical approach for relief of isolated subaortic and midventricular obstruction. Patients with severe mitral insufficiency and mitral valve replacement were identified as a problematic group. The total hospital mortality was 8.3% (9 of 108 patients), 7.9% (7 of 96 patients) in the typical group, and 16.7% (2 of 12 patients) in the atypical group. Postoperative cardiological follow-up indicates the superior effect of surgery as compared to drug therapy. The late mortality for the medical group was 10% and for the postoperative group 2.5%. These facts support our recommendation for the surgical treatment of HOCM in symptomatic patients in clinical stages III and IV (NYHA).