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[Obstructive hypertrophic cardiomyopathy: medical or surgical treatment?]
O Azzano1, J P Garé, G de Gevigney
1Hôpital cardiologique, BP Lyon-Montchat.
Insights
Surgical intervention for hypertrophic obstructive cardiomyopathy (HOCM) in severe cases offers improved survival and functional capacity compared to medical management. This study highlights better outcomes for operated patients despite initial disease severity.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Internal Medicine
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a significant cardiac condition affecting survival and functional capacity.
- Treatment strategies include medical management and surgical intervention, with varying outcomes based on disease severity.
Purpose of the Study:
- To assess and compare the survival and functional outcomes of medical versus surgical treatments for hypertrophic obstructive cardiomyopathy (HOCM).
- To evaluate the efficacy of surgical interventions, including myomectomy and mitral valve replacement, in managing HOCM.
Main Methods:
- Retrospective study of 73 patients diagnosed with HOCM between 1981 and 1991.
- Patients were divided into two groups: 24 underwent surgery (Group 1) and 49 received medical treatment (Group 2).
- Comparison of clinical characteristics, including NYHA class, cardiac failure history, atrial fibrillation, intraventricular pressure gradient, pulmonary arterial pressure, cardiac index, and mitral regurgitation severity.
Main Results:
- Patients in the surgical group (Group 1) presented with more severe HOCM, including higher NYHA class, increased incidence of prior cardiac failure, atrial fibrillation, elevated pressure gradients, and mitral regurgitation.
- Despite greater initial severity, the surgical group experienced a low abnormal mortality rate of 2.4% over a mean follow-up of 3.4 years.
- Medical management (Group 2) was associated with a higher family history of HOCM or sudden death.
Conclusions:
- Surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM), even in patients with severe disease, appears to yield favorable survival and functional outcomes.
- The study suggests that surgical intervention is a viable and effective option for managing severe HOCM.
- Further research may be warranted to explore long-term functional capacity improvements post-surgery.
Abstract:
This retrospective study assesses the results of medical and surgical treatment on survival and functional capacity of patients with hypertrophic obstructive cardiomyopathy (HOCM). Between 1981 and 1991, 73 patients were referred for treatment of HOCM: 24 were operated (Group 1) and 49 were treated medically (Group 2). Patients in Group 1 had more severe forms of HOCM than those in Group 2: 83% were in > or = NYHA Class III compared with only 20% in Group 2 (p = 0.003); 42% had previous cardiac failure compared with 16% in Group 2 (p = 0.02); 29% had atrial fibrillation compared with only 8% in Group 2 (p = 0.004); the average intraventricular pressure gradient was 78 mmHg compared with 42 mmHg in Group 2 (p = 0.001); mean pulmonary arterial pressures were 24 mmHg compared with 15 mmHg in Group 2 (p < 0.001); the cardiac index was 2.2 l/min/m2 compared with 2.7 l/min/m2 in Group 2 (p = 0.001); Sellers > or = grade 3 mitral regurgitation was present in 48% compared with 12% in Group 2 (p = 0.002). However, a family history of HOCM or of sudden death was commoner in Group 2 (28% vs 4% in Group 1: p = 0.03). Surgery consisted of myomectomy alone (5 patients) or associated with mitral valve replacement (MVR) (17 patients) or MVR alone (2 patients). Two patients in Group 1 died (1 perioperative death, 1 late death due to dissection of the aorta), giving over a 3.4 +/- 3.0 year follow-up period without any losses to follow-up, an abnormal mortality of 2.4%.(ABSTRACT TRUNCATED AT 250 WORDS)