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1.
Int J Mol Sci ; 22(5)2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33804404

RESUMO

Left Ventricular Outflow Tract (LVOT) obstruction occurs in approximately 70% of Hypertrophic Cardiomyopathy (HCM) patients and currently requires imaging or invasive testing for diagnosis, sometimes in conjunction with provocative physiological or pharmaceutical stimuli. To identify potential biomarkers of LVOT obstruction, we performed proteomics profiling of 1305 plasma proteins in 12 HCM patients with documented LVOT obstruction, referred for surgical myectomy. Plasma was collected at the surgical preoperative visit, approximately one month prior to surgery and then at the post-surgical visit, approximately 3 months later. Proteomic profiles were generated using the aptamer-based SOMAscan assay. Principal Component Analysis using the highest statistically significant proteins separated all preoperative samples from all postoperative samples. Further analysis revealed a set of 25 proteins that distinguished the preoperative and postoperative states with a paired t-test p-value of <0.01. Ingenuity Pathway analysis facilitated the generation of protein interaction networks and the elucidation of key upstream regulators of differentially expressed proteins, such as interferon-γ, TGF-ß1, and TNF. Biological pathways affected by surgery included organ inflammation, migration, and motility of leukocytes, fibrosis, vasculogenesis, angiogenesis, acute coronary events, endothelial proliferation, eicosanoid metabolism, calcium flux, apoptosis, and morphology of the cardiovascular system. Our results indicate that surgical relief of dynamic outflow tract obstruction in HCM patients is associated with unique alterations in plasma proteomic profiles that likely reflect improvement in organ inflammation and physiological function.


Assuntos
Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Inflamação/prevenção & controle , Proteoma/análise , Adulto , Idoso , Cardiomiopatia Hipertrófica/metabolismo , Cardiomiopatia Hipertrófica/patologia , Feminino , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade
2.
J Card Surg ; 36(4): 1282-1288, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33547670

RESUMO

BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is one of the most common genetic cardiac diseases and encompasses an array of clinical presentations. Little is known about the impact of genetic background on outcomes after septal myectomy (SM). The aim of this study was to evaluate the effect of specific genetic mutations on midterm outcomes in adults undergoing SM for HOCM. METHODS: From 2003 to 2020, a total of 59 patients (male = 66%, mean age = 52 ± 13) underwent SM after a preoperative genetic test. Patients were divided into two groups according to their test result (positive or negative). Preoperative echocardiograms were examined to identify phenotypical characteristics of each mutation. RESULTS: A total of thirty-one patients (53%) had a positive genetic test. MYBPC3 was the most common mutation (15/31 patients). Four different phenotypes were identified on preoperative echocardiograms. Overall, Type 1 phenotype was the most common (37% of the cohort). Type 3 was found exclusively in patients with a positive genetic test. Following SM, none of the patients required a redo myectomy or septal ablation. At 10 years, the survival was 97 ± 3% and 100% in patients with a positive and negative genetic test (p = .33), respectively. CONCLUSION: Although our results suggest that the multiple gene mutations present with different characteristics and phenotypes, midterm results of SM appear to be good regardless of genetic mutation presence.


Assuntos
Cardiomiopatia Hipertrófica , Ablação por Cateter , Testes Genéticos , Adulto , Idoso , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Sci Rep ; 10(1): 21908, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318610

RESUMO

We sought to investigate the prevalence, functional characteristics, and clinical significance of right ventricular (RV) involvement in patients with hypertrophic cardiomyopathy (HCM). A total of 256 patients with HCM who underwent both cardiac magnetic resonance (CMR) imaging and transthoracic echocardiography within 6 months of each other were retrospectively analysed. RV involvement was defined as an increased RV wall thickness ≥ 7 mm on CMR in the segments of the RV free wall. Primary outcomes were defined as the composite of all-cause death, heart transplantation, and unplanned cardiovascular admission. Thirty-seven (14.4%) patients showed RV involvement. Patients with RV involvement showed a significantly higher left ventricular (LV) maximal wall thickness and left atrial volume index. Multivariate Cox model revealed that RV involvement was independently associated with primary outcomes (HR: 2.30, p = 0.024). In a subgroup analysis of patients with speckle tracking echocardiography (n = 190), those with RV involvement had significantly more impaired RV strain, which was independently associated with primary outcomes. RV involvement in patients with HCM correlated with more advanced LV structure and biventricular dysfunction, suggesting an indicator of severe HCM. RV involvement and impaired RV strain have a prognostic value related to clinical adverse events in patients with HCM.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Imagem por Ressonância Magnética , Modelos Cardiovasculares , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Adulto , Idoso , Cardiomiopatia Hipertrófica/mortalidade , Cardiomiopatia Hipertrófica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Disfunção Ventricular Direita/mortalidade , Disfunção Ventricular Direita/cirurgia
4.
J Card Surg ; 35(11): 2957-2964, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33111447

RESUMO

OBJECTIVE: To assess outcomes of concomitant ablation for atrial fibrillation (AF) in patients with preoperative AF undergoing septal myectomy for hypertrophic obstructive cardiomyopathy. METHODS: From 2005 to 2016, 67 patients underwent concomitant ablation for AF and septal myectomy and had a follow-up beyond a 3-month blanking period. Ablation strategy (pulmonary vein isolation [PVI], modified Cox-maze III [CM-III], or Cox-maze IV [CM-IV]) was tailored to preoperative AF burden, with high AF burden defined as persistent AF or need for cardioversion. AF recurrence was analyzed as a time-related event and predictors of recurrence identified using a random forest methodology. RESULTS: A total of 38 patients (57%) had low AF burden and 29 (43%) high burden. Patients with low AF burden most frequently underwent PVI (68%). Patients with high AF burden more frequently underwent CM-III (62%) or CM-IV (35%). Besides the preoperative AF burden, baseline characteristics were similar between patients receiving CM-III, CM-IV, and PVI. After surgery, the maximum provoked left ventricular outflow tract (LVOT) gradient decreased from 99 ± 34 to 18 ± 11mm Hg (P < .001). Eight patients (12%) required a permanent pacemaker. Cumulative AF recurrence at 1, 2, and 5 years was 11%, 22%, and 48%, respectively. Age, low preoperative resting LVOT gradient, and large left atrial diameter were predictors of AF recurrence. CONCLUSIONS: Surgical outcomes of concomitant ablation for AF and septal myectomy are good, although recurrence of AF by 5 years is frequent.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Ablação por Cateter/métodos , Septos Cardíacos/cirurgia , Idoso , Fibrilação Atrial/etiologia , Cardiomiopatia Hipertrófica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
5.
J Card Surg ; 35(8): 2017-2024, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652778

RESUMO

OBJECTIVE: Affecting 1 in 500 individuals; hypertrophic cardiomyopathy is an autosomal dominant cardiovascular disorder which is prevalent throughout the world. Surgical myectomy (SM) and alcohol septal ablation (ASA) are two methods currently used for the management of drug refractory hypertrophic obstructive cardiomyopathy (HOCM). ASA may prove to be a useful, less invasive treatment in patients with HOCM METHODS: Electronic literature search was conducted to identify articles that discussed methods to treat drug refractory HOCM. No limits were placed on timing of the publication or the type of article. Keywords and MeSH terms were used and the results were summarized in the relevant section. RESULTS: Current evidence suggests that alcohol septal ablation is a safe and effective procedure in treating patients with HOCM with similar short- and long-term outcomes when compared with SM. CONCLUSION: ASA has been shown to be a safe and reliable procedure; imaging techniques and dedicated multi-disciplinary teams can be used to select patients with HOCM. Though SM is recommended as gold standard treatment for drug refractory HOCM, ASA may play an increasing role in the near future due an ageing population; both ASA and SM can have a beneficial role in treating those who are affected by HOCM when the appropriate group of patients are selected for each intervention.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Ablação por Cateter/métodos , Etanol/uso terapêutico , Septos Cardíacos/cirurgia , Feminino , Humanos , Masculino , Seleção de Pacientes , Fatores de Tempo , Resultado do Tratamento
7.
J Card Surg ; 35(8): 2041-2043, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32557779

RESUMO

A 59-year-old male with a history of unstable angina was diagnosed with a myocardial bridge of the left anterior descending artery (LAD) and apical variant hypertrophic cardiomyopathy (AHCM). He underwent unroofing of the myocardial bridge and a left ventricular apical myectomy. Intraoperatively, epicardial ultrasound was used to identify the myocardial bridge with systolic compression of the LAD and confirm resolution of this compression postoperatively. Furthermore, epicardial ultrasound was used for guiding the degree of apical resection of the decompressed heart. This novel use of intraoperative epicardial ultrasound can help guide surgeons preoperatively and confirm results immediately after an operation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/cirurgia , Monitorização Intraoperatória/métodos , Ponte Miocárdica/diagnóstico por imagem , Ponte Miocárdica/cirurgia , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Angina Instável/etiologia , Cardiomiopatia Hipertrófica/complicações , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/complicações
10.
Am J Cardiol ; 127: 128-134, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32402483

RESUMO

Alcohol septal ablation (ASA) and septal myectomy (SM) are therapeutic interventions for patients with hypertrophic cardiomyopathy (HC) who remain symptomatic despite medical treatment. Outcomes for both interventions in age groups ≤65 versus >65 years are scarce. We queried the National Readmission Database for adult patients undergoing either SM or ASA between 2010 and 2015 for HC. Patients were divided into 2 age-groups (≤65-years and >65-years). We aimed to compare the in-hospital mortality, complication rates, and resource utilization for each procedure between the 2 age-groups. We identified 4,358 patients with HC who underwent intervention, of which 2,113 were treated with SM and 2,245 with ASA. In-hospital mortality was 6-times higher in patients ≤65 years old who underwent SM compared with ASA (1.5% vs 0.3% odds ratio 6.2; p = 0.04); and 4-times higher in patients >65 years treated with SM compared with ASA (6.7% vs 1.7% odds ratio 4.29; p = 0.04). Blood transfusion rates and stroke were higher in patients undergoing SM, regardless of their age-group. Length of hospital stay was lower in the ASA group (3 days vs 6 days for both age groups, p <0.001) as well as median hospital costs (≤65 years old: $15,474 vs $31.531; and >65 years old: $16,672 vs $36,042, p <0.001). In conclusion, patients with HC treated with ASA had significantly lower in-hospital mortality, complications rates, length of hospital stay, and hospital costs compared with patients undergoing SM at any age.


Assuntos
Técnicas de Ablação/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Etanol/farmacologia , Septos Cardíacos/cirurgia , Idoso , Cardiomiopatia Hipertrófica/mortalidade , Feminino , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
Cardiovasc Diabetol ; 19(1): 64, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404127

RESUMO

BACKGROUND: Type 2 diabetes mellitus is common in cardiovascular disease. It is associated with adverse clinical outcomes for patients who had undergone coronary artery bypass and valve operations. The aim of this study was to evaluate the impact of type 2 diabetes mellitus on the midterm outcomes of patients with hypertrophic cardiomyopathy who underwent septal myectomy. METHODS: We retrospectively analyzed the data of 67 hypertrophic cardiomyopathy patients with type 2 diabetes mellitus who underwent septal myectomy from two medical centers in China from 2011 to 2018. A propensity score-matched cohort of 134 patients without type 2 diabetes mellitus was also analyzed. RESULTS: During a median follow-up of 28.0 (interquartile range: 13.0-3.0) months, 9 patients died. The cause of death of all of these patients was cardiovascular, particularly sudden cardiac death in 3 patients. Patients with type 2 diabetes mellitus had a higher rate of sudden cardiac death (4.5% vs. 0.0%, p = 0.04). The Kaplan-Meier survival analysis revealed that the rates of predicted 3-year survival free from cardiovascular death (98.1% vs. 95.1%, p = 0.14) were similar between the two groups. However, the rates of predicted 3-year survival free from sudden cardiac death (100% vs. 96.7%, p = 0.01) were significantly higher in hypertrophic cardiomyopathy patients without type 2 diabetes mellitus than in those with type 2 diabetes mellitus. Furthermore, after adjustment for age and sex, only N-terminal pro-brain natriuretic peptide (hazards ratio: 1.002, 95% confidence interval: 1.000-1.005, p = 0.02) and glomerular filtration rate ≤ 80 ml/min (hazards ratio: 3.23, 95% confidence interval: 1.34-7.24, p = 0.047) were independent risk factors for hypertrophic cardiomyopathy patients with type 2 diabetes mellitus. CONCLUSIONS: Hypertrophic cardiomyopathy patients with and without type 2 diabetes mellitus have similar 3-year cardiovascular mortality after septal myectomy. However, type 2 diabetes mellitus is associated with higher sudden cardiac death rate in these patients. In addition, N-terminal pro-brain natriuretic peptide and glomerular filtration rate ≤ 80 ml/min were independent risk factors among hypertrophic cardiomyopathy patients with type 2 diabetes mellitus.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiomiopatia Hipertrófica/cirurgia , Morte Súbita Cardíaca/epidemiologia , Diabetes Mellitus Tipo 2/mortalidade , Septos Cardíacos/cirurgia , Adulto , Pequim/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/mortalidade , Cardiomiopatia Hipertrófica/fisiopatologia , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Ann Thorac Surg ; 110(3): 783-789, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32389564

RESUMO

BACKGROUND: To assess the long-term clinical and echocardiographic outcomes of the edge-to-edge mitral repair added to septal myectomy in patients with mitral regurgitation (MR) and hypertrophic obstructive cardiomyopathy. METHODS: This is a single-center study of 26 patients with hypertrophic obstructive cardiomyopathy (septal thickness 17 ± 3 mm, resting left ventricular outflow tract gradient 63 ± 20 mm Hg, MR ≥ 2+/4+) who underwent an EE mitral procedure combined with ventricular septal myectomy. The EE procedure was used to treat MR due to systolic anterior motion in 19 patients (73%) and to posterior leaflet prolapse/flail in 7 (27%). RESULTS: Hospital mortality was 4%. Follow-up was 100% complete (median 6.5 years; interquartile range, 2.7 to 9). Freedom from cardiac death was 88% ± 8.4% at 8 years. The 8-year cumulative incidence function of reoperation with death as competing risk was 7.7% ± 5.2%. At 8 years, the cumulative incidence function of recurrence of MR 3+ or greater with death as competing risk was 7.9% ± 5.3%. Residual MR at discharge (hazard ratio 8.3; 95% confidence interval, 2.1 to 32.6; P = .002) and preoperative systolic pulmonary artery pressure (hazard ratio 1.0; 95% confidence interval, 1.0 to 1.1; P = .005) were identified as predictors of MR recurrence. At the last follow-up, 92% of patients were in New York Heart Association functional class I-II, and 72% were in sinus rhythm. The last echocardiographic follow-up showed a median resting left ventricular outflow tract gradient of 9 mm Hg (interquartile range, 7 to 12; P < .001 vs preoperative). CONCLUSIONS: In hypertrophic obstructive cardiomyopathy patients, when septal thickness was considered inadequate to allow a safe and effective myectomy, the edge-to-edge technique provided a simple, quick, and effective solution by abolishing at the same time residual gradient and systolic anterior motion-related MR. Organic mitral valve lesions such as prolapse and flail could be addressed as well, whenever indicated. Satisfactory clinical and echocardiographic results were maintained at long-term follow-up.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Adulto , Idoso , Débito Cardíaco , Cardiomiopatia Hipertrófica/mortalidade , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(4): 294-301, 2020 Apr 24.
Artigo em Chinês | MEDLINE | ID: mdl-32370480

RESUMO

Objective: To evaluate the long-term outcome of patients with hypertrophic obstructive cardiomyopathy(HOCM) after percutaneous transluminal septal ablation(PTSMA). Methods: HOCM patients who underwent PTSMA and surgical myectomy at the Chest Hospital of Shanghai Jiao Tong University from April 2001 to February 2019 were included in this retrospective analysis. Patients were divided into PTSMA group and surgical myectomy group. In addition, patients undergoing PTSMA were further divided into HOCM-PTSMA non-survivor group and HOCM-PTSMA survivor group. The general clinical information, procedural/surgical information and complications during hospitalization were compared between groups. Multivariate Cox regression model was used to analyze the independent risk factors for all-cause death in HOCM patients after PTSMA. Results: A total of 104 patients with HOCM who underwent PTSMA were enrolled. Mean age of the patients was (54±15) years old, including 41 females (38.7%). The follow-up time was 37.5(14.3, 76.8) months. At the last follow-up, 12 patients died (HOCM-PTSMA non-survivor group) and 92 were alive(HOCM-PTSMA survivor group). The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher(P=0.036), and the posterior wall of the left ventricle was thicker(P=0.006) in the HOCM-PTSMA non-survivor group than in the HOCM-PTSMA survivor group. The immediate success rate of PTSMA in this cohort was 66%(70/104). The amount of absolute alcohol during the operation in the HOCM-PTSMA non-survivor group was (2.9±0.8) ml, which tended to be higher as compared to that in the HOCM-PTSMA survivor group((2.4±1.0)ml, P=0.056). Kaplan-Meier survival curve analysis showed that patients with HOCM who underwent PTSMA had an all-cause mortality-free survival rate of 90.1%, 78.3%, and 56.9% at 5, 10 and 15 years, and a HOCM-free survival rate of 91.3%, 79.4% and 57.7% at 5, 10 and 15 years, respectively. Multivariate Cox regression analysis showed that age≥ 65 years was an independent risk factor for all-cause death after PTSMA in patients with HOCM (HR=2.697, 95%CI 1.292-18.977, P=0.020). There were 32 patients in the surgical myectomy group. The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher than that in the PTSMA group(P<0.001), while age, gender, and major comorbidities(atrial fibrillation, coronary heart disease, hypertension, and diabetes) as well as the left atrium dimension were all similar between the two groups(all P>0.05). Patients in the surgical myectomy group were followed up for 38.0(17.6, 64.2)months, and no deaths occurred during the follow-up period. Kaplan-Meier survival curve analysis showed that there were no statistically significant differences in all-cause-free and HOCM-free survival rates between patients in PTSMA group and surgical myectomy group(P=0.089 and 0.110, respectively). Conclusion: PTSMA is safe and effective for the treatment of patients with HOCM, and the long-term survival rate of patients after PTSMA is similar as patients undergoing classical surgical myectomy surgery.


Assuntos
Cardiomiopatia Hipertrófica , Ablação por Cateter , Adulto , Idoso , Cardiomiopatia Hipertrófica/cirurgia , China , Feminino , Seguimentos , Septos Cardíacos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Am J Cardiol ; 125(12): 1890-1895, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32305221

RESUMO

Alcohol septal ablation (ASA) is indicated for symptomatic hypertrophic cardiomyopathy (HC) patients. We sought to analyze the incidence of the 30-day readmission rate, predictors, causes of readmission, and incremental healthcare resource (cost and length of stay) utilization after ASA. Nationwide Readmission Database from 2010 January to 2015 September was queried to identify 30-day unplanned readmission after ASA for HC by using the International Classification of Disease, 9th Revision, Clinical Modification. Those readmitted were similar in terms of age and sex but had higher burden of co-morbidities compared with those not readmitted within 30-days. The 30-day unplanned readmission rate was 10.4% (511/4,932) after ASA. Readmissions lead to an additional mean hospitalization cost of 8,433 US dollars and mean of 4.9 days of length of stay. Predictors of 30-day unplanned readmission were liver disease (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 1.22 to 5.59), renal failure (aOR 2.30, 95%CI 1.52 to 3.50), previous myocardial infarction (aOR 1.97, 95%CI 1.16 to 3.33), previous pacemaker (aOR 1.50, 95%CI 1.09 to 2.08), atrial fibrillation (aOR 1.43, 95%CI 1.08 to 1.89), Medicaid (aOR 1.74, 95%CI 1.12 to 2.68), and weekend admission (aOR 1.75, 95%CI 1.12 to 2.75). Common reasons for readmissions were atrial fibrillation (12.6%), acute on chronic systolic heart failure (12.6%), paroxysmal ventricular tachycardia (6.4%), atrioventricular block (4.9%), and HC (3.0%). Unplanned readmissions after ASA occur in patients with higher burden of co-morbidities and are mainly caused by cardiac etiologies.


Assuntos
Técnicas de Ablação/métodos , Cardiomiopatia Hipertrófica/cirurgia , Etanol , Septos Cardíacos/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
17.
Am J Cardiol ; 125(9): 1421-1428, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32145895

RESUMO

The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were: hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities. Additionally, patients with uncommon cardiomyopathies were less implanted as destination therapy compared with ischemic/idiopathic group (29% vs 38.8%). During a follow-up period of 9.1 months, both groups experienced similar survival. However, subgroup of hypertrophic/valvular cardiomyopathies and CTRCD had significantly higher mortality compared to the ischemic/idiopathic or myocarditis/others cardiomyopathies. Conversely, patients with myocarditis/others etiologies experienced a better survival. Indeed, the 12-months survival in the myocarditis/others; ischemic/idiopathic and hypertrophic/CTRCD/valvulopathy group were 77%; 65%, and 46% respectively. In conclusion, LVAD-recipients with hypertrophic cardiomyopathy, valvular heart disease and CTRCD experienced the higher mortality rate.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Coração Auxiliar , Isquemia Miocárdica/cirurgia , Adulto , Idoso , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Hipertrófica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Estudos Retrospectivos , Resultado do Tratamento
18.
Mayo Clin Proc ; 95(3): 521-525, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32138879

RESUMO

Severe coronary artery disease is associated with disproportionately increased risks of death in patients with hypertrophic cardiomyopathy. There is a paucity of data on the long-term effect of coronary revascularization at the time of myectomy. Between January 1, 1961, and October 31, 2017, 2913 adult patients underwent transaortic septal myectomy at Mayo Clinic. Concomitant coronary artery bypass grafting (CABG) was performed in 246 (8.4%). We compared baseline characteristics of patients who underwent septal myectomy with and without CABG and assessed the effect of surgical revascularization on the risk of all-cause mortality. Patients who underwent concomitant CABG were older (median [interquartile range], 66.3 [59.8-72.1] years vs 54.4 [43.5-64.8] years; P<.0001) and more likely to be male (63.0% vs 54.2%; P=.008) than those who did not undergo coronary revascularization at operation. There was no significant difference in preoperative left ventricular outflow tract gradients (55 [25-81] mm Hg vs 58 [25-88] mm Hg; P=.116). Overall operative mortality (≤30 days after surgery) was 1.0% and higher in patients who underwent concomitant CABG (2.2% vs 0.8%; P=.048). In multivariable analysis (n=2641), factors independently associated with mortality included concomitant CABG (hazard ratio [95% CI], 1.89 [1.39-2.58]; P<.0001), older age at operation (per interquartile range increase, 2.79 [1.95-3.98]; P<.0001), atrial fibrillation (1.46 [1.11-1.92]; P=.006), diabetes (1.45 [1.04-2.04]; P=.031), higher body mass index (change from 0.95 to 0.5 quantile, 1.95 [1.46-2.59]; P<.0001), and surgery performed earlier in the study period (2.02 [1.31-3.11]; P=.001). In conclusion, obstructive coronary artery disease severe enough to prompt concomitant CABG at the time of septal myectomy is an important risk factor for late mortality.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Septos Cardíacos/cirurgia , Adulto , Idoso , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/mortalidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
19.
Catheter Cardiovasc Interv ; 95(4): 838-839, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32159290

RESUMO

Evaluation of the severity of aortic stenosis in the presence of dynamic left ventricular outflow (LVOT) obstruction is challenging. Invasive hemodynamic assessment with provocative maneuvers can be useful to differentiate of the relative components of obstruction. In patients with both dynamic LVOT obstruction and aortic stenosis, surgical myectomy and concurrent surgical aortic valve replacement is the optimal treatment strategy; combined alcohol septal ablation and transcatheter aortic valve replacement should only be considered for very high surgical risk patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Obstrução do Fluxo Ventricular Externo/cirurgia , Valva Aórtica , Constrição Patológica , Humanos , Resultado do Tratamento
20.
Cardiology ; 145(3): 161-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32007988

RESUMO

OBJECTIVE: Mitral regurgitation (MR) induced by systolic anterior motion in patients with hypertrophic cardiomyopathy (HCM) can frequently be abolished with a proficient septal myectomy (SM) without the need for mitral-valve replacement (MVR). ACC guidelines stress the importance of volume in improving outcomes after SM, but there is a lack of data measuring the impact of volume on the need for MVR during SM. This study was designed to assess the impact of institutional volume on MVR rates using national outcomes data. METHODS: The Nationwide Inpatient Sample was queried from 1998 to 2011 and a total of 6,207 patients had a diagnosis of HCM and a procedure code for SM. Outcomes were compared between patients who underwent SM (group I) and SM and MVR (group II). Furthermore, patients were stratified into 3 groups based on the number of SMs at the performing institution: low experience (1-24 cumulative SMs), medium experience (25-49 SMs), and high experience (>50 SMs). These patients underwent multivariable analysis to determine the impact of institutional volume on MVR rate. RESULTS: The total MVR rate was 26%. Perioperative outcomes were worse, i.e., there were higher rates of mortality, kidney injury, and urinary complications, in group II than in group I. Only 37.6% of patients were operated on at institutions meeting the guideline criteria of >50 cumulative SMs. When compared to patients in the high-experience group, patients in the low- (OR 2.7, 95% CI 2.3-3.2, p < 0.05) and medium-experience (OR 3.0, 95% CI 2.5-3.6, p < 0.05) groups were more likely to undergo MVR. CONCLUSION: Compared to reports from SM reference centers, national data suggest that MVR rates are quite high at SM. Patients undergoing SM at centers that do not meet the guideline standard have >2.5× the odds of undergoing MVR compared to those operated on at guideline-endorsed centers.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Idoso , Bases de Dados como Assunto , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos
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