Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel.
Am J Cardiol
; 180: 124-139, 2022 10 01.
Article
en En
| MEDLINE
| ID: mdl-35965115
ABSTRACT
Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on >50 years experience, surgery reliably reverses disabling heart failure by permanently abolishing mechanical outflow impedance and mitral regurgitation, with normalization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increasing significantly in number over the most recent 15 years. Performed in experienced multidisciplinary institutions, perioperative mortality for myectomy has declined to 0.6%, becoming one of the safest currently performed open-heart procedures. Extended myectomy relieves symptoms in >90% of patients by ≥ 1 NYHA functional class, returning most to normal daily activity, and also with a long-term survival benefit; concomitant Cox-Maze procedure can reduce the number of atrial fibrillation episodes. Surgery, preferably performed in high volume clinical environments, continues to flourish as a guideline-based and preferred high benefit low treatment risk option for adults and children with drug refractory disabling symptoms from obstruction, despite prior challenges higher operative mortality/skepticism in 1960s/1970s; dual-chamber pacing in 1990s, alcohol ablation in 2000s, and now introduction of novel negative inotropic drugs potentially useful for symptom management.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
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Cardiomiopatía Hipertrófica
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Obstrucción del Flujo Ventricular Externo
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Procedimientos Quirúrgicos Cardíacos
Tipo de estudio:
Guideline
Límite:
Adult
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Child
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Humans
Idioma:
En
Año:
2022
Tipo del documento:
Article