We need more high‐volume myectomy centres in Europe

Spirito, Paolo; Ferrazzi, Paolo

doi:10.1002/ejhf.1061

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…140 Myectomy is preferably performed in high volume experienced multidisciplinary centers dedicated to HCM, and there is a need to establish additional such programs to expand surgical expertise and patient access to this important treatment option. [140][141][142][143][144][145][146] By relieving symptoms and reversing HF, and consequently returning the overwhelming majority of patients to an unrestricted normal lifestyle, myectomy can provide one of the most striking clinical benefits achievable in cardiovascular medicine. This is particularly notable given the relatively young age of patients in mid-life often at the time of operation (average, early 50s), with decades of life remaining during which the impact of myectomy can be realized.…”

Section: Discussionmentioning

confidence: 99%

“…A particularly important future challenge is to disseminate and enhance surgical experience in the U.S. and globally, [140][141][142][143][144][145][146] including in Europe 143,144 and those after populous regions and countries where substantial numbers of HCM patients reside (e.g., China and India). 97,[144][145][146] Without access to myectomy many such symptomatic patients will unavoidably experience progressive disability and possibly shortened life expectancy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel

Maron

Dearani

Smedira

et al. 2022

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel

Maron

Dearani

Smedira

et al. 2022

The American Journal of Cardiology

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“…The requirement for superb surgical skills available in only in a few centers has resulted in reduced utilization particularly in Europe where alcohol ablation became the dominant septal reduction strategy (24). There are a few strong international myectomy programs in Italy, Israel, Belgium, the Netherlands and China but a need for more septal myectomy surgeons and more septal myectomy centers in Europe has been expressed (24)(25)(26). The most recent HCM guideline statement recommends 10 myectomies per operator/year as reasonable experience (10), a goal that can be met by a comparatively few centers particularly in Europe.…”

Section: Treatment Of Hocmmentioning

confidence: 99%

“…Alcohol septal ablation has the advantage of being less invasive than surgical myectomy, requires less hospitalization and has a shorter recovery period. The less invasive procedure with earlier return to active life style has resulted in an increase in use of alcohol septal ablation worldwide and a reduction in surgical myectomy (24)(25)(26).…”

Section: Treatment Of Hocmmentioning

confidence: 99%

Current state of the roles of alcohol septal ablation and surgical myectomy in the treatment of hypertrophic obstructive cardiomyopathy

Douglas¹

2020

Cardiovasc Diagn Ther

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Hypertrophic cardiomyopathy is a genetically determined disorder resulting in left ventricular hypertrophy. In a majority of the estimated 20 million people affected worldwide, left ventricular outflow obstruction is present at rest or with provocation. The presence and degree of obstruction influence the symptomatic presentation, treatment strategies and prognosis of affected individuals. Pharmacologic therapy with beta-adrenergic blocking drugs and calcium channel blockers is the principal treatment strategy in symptomatic patients with left ventricular outflow obstruction but is ineffective in many patients. When symptoms of exertional shortness of breath, chest pain and/or syncope prove refractory to medical therapy and there is persisting left ventricular outflow obstruction, or when there is drug intolerance, septal reduction strategies (surgical myectomy and alcohol septal ablation) are quite effective. Selection of the optimal septal reduction strategy for a given patient has become controversial and is determined largely by the medical system providing treatment strategies for the patient. Regretably, there are no randomized trials comparing myectomy and ablation and none are anticipated. The comprehensive Hypertrophic Cardiomyopathy Guideline Statements published in 2011 and 2014 differ significantly with the earlier statement favoring surgical myectomy and the more recent statement giving equal class I status to the two septal reduction strategies in adult patients with drug-refractory symptoms. Recently published studies of long-term followup of patients after alcohol septal ablation in Europe, where surgical myectomy is rarely performed, confirm long-term safety and effectiveness with survival free of cardiac events exceeding 96% at 15 years. The lesser degree of discomfort and more rapid recovery associated with the minimally invasive catheter-based alcohol ablation procedure coupled with the recently published long-term safety data favor an increased use of this strategy in symptomatic adult patients with hypertrophic obstructive cardiomyopathy (HOCM).

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“…The advantages of ASA lead to its increased use vs. the reduced use of SM worldwide, especially in Europe ( 7 ). Therefore, several experienced surgeons successively appealed to more SM surgeons and high-volume centers ( 8 , 9 ). Furthermore, there are limited data and reports in terms of surgical outcomes of the subgroup of HOCM patients older than 60 years.…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic Trans-mitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy in the Elderly

Wei

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe thoracoscopic trans-mitral approach can not only facilitate exposure of the ventricular septum, mitral valve, and subvalvular apparatus, it also enables the surgeons to perform concomitant mitral valve intervention. This study aimed to determine the safety and efficacy of thoracoscopic trans-mitral septal myectomy in elderly patients with hypertrophic obstructive cardiomyopathy (HOCM).MethodsWe reviewed the demographic to clinical characteristics and outcomes of patients who underwent thoracoscopic trans-mitral septal myectomy in our center between April 2019 and April 2021. The population was divided into a younger group (<60 years) and an elderly group (≥60 years).ResultsThere were 46 and 20 patients in the younger and elderly groups, respectively. The majority of patients in the elderly group were female (39.1 vs. 80.0%, P < 0.01). Patients in the elderly group were more likely to be in New York Heart Association Class IV (2.2 vs. 80.0%, P < 0.01). The European System for Cardiac Operation Risk Evaluation II predicted mortality rates were significantly higher (3.97 ± 1.81 vs. 1.62 ± 0.86%, P < 0.01) in the elderly group. In the elderly group, a patient converted to median sternotomy due to left ventricular posterior free wall rupture following septal myectomy and mitral bioprosthetic valve replacement. The patient then underwent double-patch sandwich repair for rupture and mitral mechanical valve replacement and was eventually discharged. All patients in the elderly group were discharged, while one in the younger group died. No patient in the elderly group required permanent pacemaker implantation vs. one in the younger group. Patients in the elderly group were more likely to spend more time in the intensive care unit than those in the younger group (5.44 ± 5.80 days vs. 3.07 ± 2.72, P < 0.05). However, there was no significant intergroup difference in in-hospital mortality or complications. Importantly, the left ventricular outflow tract pressure gradient was significantly decreased from 96.15 ± 32.89 mmHg to 8.2 ± 3.42 mmHg with no residual obstruction in the elderly group. The interventricular septal thickness was significantly decreased from 19.73 ± 3.14 mm to 11.30 ± 2.23 mm. Postoperative mitral regurgitation severity was significantly improved in the elderly group.ConclusionThis study demonstrated that thoracoscopic trans-mitral septal myectomy is a feasible option for selected elderly patients with satisfactory outcomes similar to those of young patients.

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We need more high‐volume myectomy centres in Europe

Cited by 4 publications

References 17 publications

Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel

Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel

Current state of the roles of alcohol septal ablation and surgical myectomy in the treatment of hypertrophic obstructive cardiomyopathy

Thoracoscopic Trans-mitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy in the Elderly

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