Hypertrophic Obstructive Cardiomyopathy: Comparison of Outcomes After Myectomy or Alcohol Ablation Adjusted by Propensity Score

Ralph-Edwards, Anthony; Woo, Anna; McCrindle, B.W.

doi:10.1016/j.accreview.2005.05.073

Cited by 28 publications

(47 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our centre has generally performed ASA in patients with a suitable septal perforator branch and appropriate septal morphology (focal basal septal hypertrophy and color turbulence in the outflow tract). When comparing the two procedures at our centre, ASA is associated with a higher incidence of permanent pacing (9). In agreement with this data, larger series have demonstrated that patients greater than 65 years of age have greater survival, freedom from severe symptoms, and improved quality of life with isolated myectomy compared with ASA (10,11).…”

Section: Introductionsupporting

confidence: 68%

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

Vanderlaan

Woo

Ralph-Edwards

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Isolated septal myectomy is considered the gold standard for refractory left ventricular outflow tract (LVOT) obstruction at centers with dedicated hypertrophic obstructive cardiomyopathy (HOCM) surgeons. In this paper, we provide an update on the Toronto General Hospital (TGH) experience for isolated septal myectomy and comment on the safety and efficacy of myectomy in patients with thin basal septal thickness at our institution. Methods:We retrospectively reviewed all patients undergoing surgical myectomy at our institution from January 2012 to August 2016. We analyzed patient characteristics, intraoperative variables, pre-and postprocedural echocardiographic parameters, and key outcomes including post-operative stroke, renal failure, iatrogenic ventricular septal defect (VSD), post-procedure insertion of permanent pacemaker, and mortality.Results: At our institution, 150 isolated septal myectomy surgeries were performed over the study period.Preoperative echocardiography demonstrated an average basal septal thickness of 2.10±0.43 cm with a resting gradient of 67±37 mmHg and a provoked gradient of 89±40 mmHg. Fifty percent of patients had significant systolic anterior motion (SAM) of their mitral valve and 53% had associated moderate to severe mitral regurgitation (MR). Of note, 24% of patients had a thin septum of ≤1.7 cm. Discharge echocardiograms demonstrated significant septal reduction to an average basal septal thickness of 1.04±0.26 (P<0.05), with negligible resting and provokable LVOT gradients. At the time of discharge, none of the patients had significant SAM and only 5.3% of patients had residual greater than mild MR. Patients undergoing isolated myectomy with a thin basal septum had similar outcomes to those with a >1.7 cm septal thickness. In our contemporary cohort, there were no iatrogenic VSDs, 5.3% of patients required a permanent pacemaker and there was one early death.Conclusions: Our cohort demonstrates that isolated septal myectomy remains a safe and effective operation that can achieve excellent results, irrespective of basal septal thickness, when done by experienced surgeons in a dedicated hypertrophic cardiomyopathy (HCM) center.

show abstract

Section: Introductionsupporting

confidence: 68%

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

Vanderlaan

Woo

Ralph-Edwards

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…It is well known that septal myectomy provides resolution of LVOT obstruction virtually in all patients and provides superior outcomes in terms of LVOT obstruction resolution, than ASA (9,(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Septal myectomy after failed septal alcohol ablation

Bajona

Arguís

Prat‐González

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Despite septal myectomy remaining the gold standard septal reduction therapy for hypertrophic obstructive cardiomyopathy (HOCM), there has been a disproportionate use of alcohol septal ablation (ASA) worldwide.Absolute resolution of left ventricular outflow tract (LVOT) obstruction with ASA is not achieved in a substantial proportion of patients. The mechanisms of failure from ASA are partially understood and described. Residual obstruction in hypertrophic cardiomyopathy is associated with worse clinical outcomes and mortality. There is a growing number of patients who present with significant residual gradients after ASA and require a rescue septal myectomy operation, which then carries an increased risk of perioperative complications and life-long sequelae. This contrasts with the excellent outcomes achieved by septal myectomy without previous percutaneous intervention. Despite complete resolution of obstruction in rescue myectomy, the outcomes remain compromised by the prior ASA.

show abstract

“…The anatomy of the septal perforators is variable, and to a certain extent, the morphology of the hypertrophied septum can be heterogenous as well. Therefore, ASA may lead to inadequate remodeling that results in higher residual gradients as compared to surgical myectomy (43,44). Furthermore, despite several case reports depicting successful treatment of midventricular obstruction (45)(46)(47), it remains uncertain whether ASA can reliably account for the complex anatomy involving the papillary muscles that is characteristic of pure midventricular obstruction in HCM (48).…”

Section: Ablation Versus Myectomymentioning

confidence: 99%

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Hang¹,

Nguyen²,

Schaff³

2017

ASVIDE

View full text Add to dashboard Cite

Our understanding of hypertrophic cardiomyopathy (HCM) as a disease entity has increased dramatically over the last half century. There has been a concerted effort by several surgical groups to develop operative techniques to relieve left ventricular outflow tract (LVOT) obstruction and alleviate symptoms. This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. In addition, we introduce newer methods for myectomy that have expanded the role of surgery in patients with various forms of HCM.

show abstract

Hypertrophic Obstructive Cardiomyopathy: Comparison of Outcomes After Myectomy or Alcohol Ablation Adjusted by Propensity Score

Cited by 28 publications

References 0 publications

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

Septal myectomy after failed septal alcohol ablation

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Contact Info

Product

Resources

About