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Long-term follow-up in hypertrophic obstructive cardiomyopathy after septal myectomy
M H Schönbeck1, H P Brunner-La Rocca, P R Vogt
1Department of Surgery, University Hospital, Zurich, Switzerland.
Insights
Septal myectomy offers a safe and effective treatment for hypertrophic obstructive cardiomyopathy, demonstrating high long-term survival rates and symptom relief in patients.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) treatment remains debated.
- Evaluating long-term outcomes of septal myectomy in HOCM is crucial.
Purpose of the Study:
- Assess clinical and echocardiographic results after septal myectomy for HOCM.
- Identify predictors of event-free survival in HOCM patients post-myectomy.
Main Methods:
- 110 HOCM patients (2-66 years) underwent septal myectomy (1965-1995).
- Patients had either myectomy alone or combined with other procedures.
- Long-term follow-up (mean 11.7 years) and multivariate Cox regression were used.
Main Results:
- Perioperative mortality was 3.6%.
- 15-year survival rate was 72%; symptom-free survival was 33%.
- NYHA class III/IV, heart failure, and additional procedures predicted late death.
Conclusions:
- Septal myectomy shows low perioperative mortality and high late survival (72% at 15 years).
- It remains an excellent treatment for symptomatic HOCM patients.
Background:
Controversy exists about the choice of treatment for patients with hypertrophic obstructive cardiomyopathy. The purpose of this study was to evaluate clinical and echocardiographic long-term results in patients with hypertrophic obstructive cardiomyopathy after septal myectomy and to determine predictors of event-free survival in these patients.
Methods:
Between 1965 and 1995, 110 consecutive patients 2 to 66 years old (mean age, 37 +/- 15 years) with an invasively measured left ventricular outflow tract gradient of 86 +/- 39 mm Hg (81 +/- 42 mm Hg by Doppler echocardiography) underwent either septal myectomy only (n = 87) or myectomy combined with additional procedures (n = 23). Mean follow-up was 11.7 +/- 7.5 years. Predictors of late events were calculated using multivariate Cox regression analysis.
Results:
The perioperative mortality rate was 3.6% (n = 4). The cumulative survival rate at 5, 10, and 15 years was 93%, 80%, and 72%, respectively, and symptom-free survival, 77%, 50%, and 33%, respectively. Predictors of late death were New York Heart Association class III or IV (p < 0.05), congestive heart failure (p < 0.05) and additional procedures (p < 0.05). The left ventricular outflow tract gradient was nearly eliminated in all patients, the left atrial dimension decreased significantly during the early years, and left ventricular dilatation occurred late in 17 patients.
Conclusions:
Septal myectomy is associated with a low perioperative mortality and a high late survival rate (72% at 15 years' follow-up). Septal myectomy is still an excellent modality in the treatment strategy for symptomatic patients with hypertrophic obstructive cardiomyopathy.