Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy.
Asian Cardiovasc Thorac Ann
; 30(1): 74-83, 2022 Jan.
Article
en En
| MEDLINE
| ID: mdl-34757854
ABSTRACT
BACKGROUND:
We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy.METHODS:
We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution.RESULTS:
The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02-11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent.CONCLUSIONS:
The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Cardiomiopatía Hipertrófica
/
Tabiques Cardíacos
Tipo de estudio:
Guideline
/
Observational_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Humans
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Middle aged
Idioma:
En
Revista:
Asian Cardiovasc Thorac Ann
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2022
Tipo del documento:
Article