Surgical management of hypertrophic obstructive cardiomyopathy. Early and late results

Blaine Heric, Bruce W. Lytle, Dave P. Miller, Eliot R. Rosenkranz, Harry M. Level, Delos M. Cosgrove

Research output: Contribution to journalArticle

155 Scopus citations

Abstract

From 1975 through 1993, 178 patients underwent surgical management of hypertrophic obstructive cardiomyopathy. Operations included isolated septa myectomy (n=95), septal myectomy and coronary artery bypass grafting (n=41), septal myectomy plus a valve procedure (n=25), septal myectomy, valve procedure, and coronary artery bypass grafting (n=14), and mitral valve replacement without septal myectomy (n=3). Recent myectomy results were monitored with transesophageal echocardiography. After initial myectomy, 32 patients (20%) underwent a second pump run for more extensive myectomy only (n=22), mitral valve replacement only (n=5), or both (n=2). In-hospital mortality was 6% (n=11) and 4% (n=6) for patients undergoing septal myectomy or septal myectomy plus coronary artery bypass grafting, respectively. Heart block occurred in 17 patients (10%). Left ventricular outflow tract systolic gradients decreased from a mean of 93 mm Hg to 21 mm Hg after myectomy. Late survival was 86% and 70% at 5 and 10 postoperative years, respectively, and 93% and 79% for patients undergoing septal myectomy alone or septal myectomy plus coronary artery bypass grafting, respectively. Only 3 of 131 in-hospital survivors of septal myectomy or septal myectomy plus coronary artery bypass grafting died late cardiac deaths, for a yearly mortality of 0.6%. However, the 5-year late survival of patients undergoing valve operation plus septal myectomy was 51%, and multivariate testing confirmed the adverse influence on late survival (p=0.008), as well as adverse influences of increasing age (p=0.016) and return to cardiopulmonary bypass for mitral valve replacement (p=0.038). At follow-up 136 patients (94%) had New York Heart Association class I or II symptoms. For patients with hypertrophic obstructive cardiomyopathy, septal myectomy alone or in combination with coronary artery bypass grafting produces effective symptom relief, excellent long-term survival, and a low risk of late cardiac death.

Original languageEnglish (US)
Pages (from-to)195-208
Number of pages14
JournalThe Journal of Thoracic and Cardiovascular Surgery
Volume110
Issue number1
DOIs
StatePublished - Jul 1995
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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