Single-Centre Experience of Surgical Myectomy for Hypertrophic Obstructive Cardiomyopathy

Afanasyev, Alexander; Bogachev-Prokophiev, Alexander V; Овчаров, М. А.; Pivkin, Alexey; Zalesov, A.S.; Будагаев, С. А.; Sharifulin, Ravil; Железнев, С. И.; Караськов, А. М.

doi:10.1016/j.hlc.2019.07.009

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…In our single-center experience, to improve SM outcomes, we used the classic Morrow procedure to perform extended myectomy (adopted from the Schaff group, 6) from adding MVR to non-MVR, conducted several pilot studies assessing MV repair, including subvalvular apparatus intervention (adapted from Ferrazzi et all 7) and edge-to-edge repair. 11,[26][27][28] In 2019, a group from Monza 29 described a novel role of preoperative cardiac magnetic resonance (CMR), which could render SM more accessible to surgeons by defining areas of marked septal thinning. We adopted this technique, and since 2020, we have been screening most patients using CMR.…”

Section: Discussionmentioning

confidence: 99%

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Afanasyev

Bogachev-Prokophiev

Железнев

et al. 2021

Asian Cardiovasc Thorac Ann

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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.

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Section: Discussionmentioning

confidence: 99%

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Afanasyev

Bogachev-Prokophiev

Железнев

et al. 2021

Asian Cardiovasc Thorac Ann

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“…Three studies reported outcomes with median follow-up times of 5 years or greater. 10,11,18 Boll and colleagues reported freedom from all-cause mortality at 10 years of 95% (95% CI, 84%-98%), which was similar to an age-and gender-matched general US population (log-rank P = 0.43). 14 Lapenna and colleagues reported overall survival at 7 years as 87 ± 6.1%.…”

Section: Long-term Outcomesmentioning

confidence: 80%

“…Patient characteristics are summarised in Table 2. Preoperative AF burden was reported by all studies except one, 18 with the majority of patients suffering from paroxysmal AF. The proportion of patients who had a prior unsuccessful ablation for AF was reported by seven studies, ranging from 0% 16 to 19%.…”

Section: Patient Characteristicsmentioning

confidence: 91%

“…A total of 10 studies, including one observational comparative study and nine case series, met the inclusion criteria. [9][10][11][12][13][14][15][16][17][18] There were no randomised controlled trials identified. Meta-analysis was not performed as the data extracted was not suitable.…”

Section: Literature Searchmentioning

confidence: 99%

“…Similarly, Afanasyev and colleagues found that LA diameter >57.5 mm predicted late AT recurrence (Cox regression; HR 1.30, 95% CI, 1.03-1.65; P < 0.001; 83.3% sensitivity and 75.4% specificity); Boll and colleagues found LA transverse diameter >45 mm predicted postoperative AF (multivariable regression; HR 4.11, 95% CI 1.62-10.43, P < 0.01); and Bassiouny and colleagues found persistent or longstanding preoperative AF (OR 0.38, 95% CI, 17-0.88, P = 0.024) and AF duration (OR 0.66, 95% CI, 0.49-0.90, P = 0.008) predicted AF recurrence. 14,16,18 Two studies reported no stroke or thromboembolic events during their follow-up periods. 10,14 Bakir and colleagues reported significantly lower incidence of cerebrovascular incidents after myectomy + ablation, compared to myectomy alone in patients with AF (3% vs 22%, P = 0.02).…”

Section: Long-term Outcomesmentioning

confidence: 99%

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Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

Seco

Lau

Medi

et al. 2021

Asian Cardiovasc Thorac Ann

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Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

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