Clinical and Echocardiographic Determinants of Long-Term Survival After Surgical Myectomy in Obstructive Hypertrophic Cardiomyopathy

Abstract

Background-Surgical myectomy has been the standard treatment for patients with drug-refractory obstructive hypertrophic cardiomyopathy.

Resultados a longo prazo da miectomia septal no tratamento da cardiomiopatia hipertrófica

“…They also state that the survival is similar to the general population [9,10,12,23,25]. Other consistent data show that the degree of septal hypertrophy and the presence of the pressure gradient in the left ventricular outflow are related to sudden death, and this reinforces the indication for surgery [7,8].…”

“…Currently, assistance units with extensive experience present a mortality rate between 1% and 2%, being able to reach zero in most favorable situations (9,12,13). In our experience, we had an in-hospital death (2.9%) and a survival rate of 87.9% with a mean follow-up of 9.6 years, equivalent to that observed in the international experience, with an 5-year overall survival ranging from 86% up to 96% and in 10 years between 70% and 90% [9,10,12,13]. The recent consensus of American and European Societies of Cardiology have highlighted the surgical septal myectomy as the "gold standard" to reduce the left ventricular outflow obstruction tract and to relief the symptoms in patients with hypertrophic obstructive cardiomyopathy [22].…”

“…In addition to the age (³ 50 years), other factors have been reported and include female gender, family history of sudden death, prior history of syncope, severe septal hypertrophy, presence of ventricular tachycardia, and abnormal blood pressure response to exercise [3,4,9,22,23]. Echocardiographic factors may also influence the long-term survival after myectomy, such as the diameter of the left atrium (³ 46 mm) and the ratio septum/ posterior wall ³ 1.8, as well as associated procedures such as coronary artery bypass grafting [9].…”

Surgery for Hypertrophic Obstructive Cardiomyopathy

“…3,4 Relief of obstruction with myectomy is immediate (and often necessary in severely symptomatic patients), permanent, and virtually complete. Indeed, Woo et al 15 report that 98% of their patients had no significant outflow gradient at rest at the most recent echocardiographic examination (mean 5.5 years and up to 25 years after operation). Furthermore, only the surgical approach affords the flexibility under direct anatomic visualization that is often necessary to achieve complete repair and relief of subaortic obstruction, given the complex LV outflow tract morphology frequently encountered in HCM.…”

“…Pioneered by Dr Andrew Morrow at the National Institutes of Health, 5 septal myectomy and related operations have been performed in a number of largely North American and Western European centers. 6 -14 In this issue of Circulation, Woo et al 15 report one of the most important single-center surgical series encompassing 338 adult patients consecutively assembled over 25 years at Toronto General Hospital, with Dr William G. Williams as the senior operating surgeon. 6 Septal myectomy is traditionally performed through an aortotomy, creating a rectangular trough (usually 3.5 to 5.0 cm in length) by 2 parallel longitudinal incisions in the basal septum (2 to 3.5 cm apart).…”