839-1 The long-term effect of surgical myectomy on survival in patients with obstructive hypertrophic cardiomyopathy

Ommen, Steve R.; Olivotto, Iacopo; Maron, Martin S.; Betocchi, Sandro; Cecchi, Franco; Ackerman, Michael J.; Gersh, Bernard J.; Dearani, Joseph A.; Schaff, Hartzell V.; Nishimura, Rick A.; Maron, Barry J.

doi:10.1016/s0735-1097(04)90912-6

Cited by 10 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After septal myectomy, long-term actuarial survival was 99%, 98%, and 95%, at 1, 5, and 10 years, respectively (when considering HCM-related mortality). Survival of myectomy patients did not differ from that expected in a matched general U.S. population and, in fact, was superior to that achieved by non-operated obstructed patients (75). Myectomy was also associated with reduced long-term risk for sudden cardiac death (75), suggesting that the long-term consequences of surgical myectomy and ablation may well be paradoxical in this regard-that is, myectomy can decrease sudden death risk, whereas ablation may increase that risk (at least in some patients) (1).…”

Section: Post-surgical Resultsmentioning

confidence: 51%

“…Whether relief of outflow obstruction by septal myectomy also extends the longevity of patients with HCM has been an important but largely unresolved issue, owing to the impracticality and ethical considerations involved in designing a controlled trial comparing patients randomized to surgery and other treatments. Nevertheless, previous reports (46,49,52-55,59 -61,64) and a recently available retrospective and controlled analysis of the Mayo Clinic surgical series (75) provide evidence that myectomy results in excellent long-term survival, may alter the natural history of the disease, and consequently obstructive HCM could be regarded as a surgically correctable form of heart failure in many severely symptomatic patients. After septal myectomy, long-term actuarial survival was 99%, 98%, and 95%, at 1, 5, and 10 years, respectively (when considering HCM-related mortality).…”

Section: Post-surgical Resultsmentioning

confidence: 99%

“…Gradient reduction results from basal septal thinning with resultant widening of the LV outflow tract area (and re-direction of forward flow with loss of the drag and Venturi effects on mitral valve) (15)(16)(17), and consequently abolition of systolic anterior motion of the mitral valve and mitral-septal contact (16,18,65,70,71,73). Mitral regurgitation is usually virtually eliminated without the need for additional mitral valve surgery (72), left atrial size (and possibly the long-term risk for atrial fibrillation) are reduced (7,11,28,74), and LV systolic and end-diastolic pressures as well as wall stress are normalized (1,2,7,11,15,72,73,75). Long-term survival.…”

Section: Post-surgical Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The case for surgery in obstructive hypertrophic cardiomyopathy

Maron

Dearani

Ommen

et al. 2004

Journal of the American College of Cardiology

196

114

View full text Add to dashboard Cite

Relief of left ventricular (LV) outflow obstruction in patients with hypertrophic cardiomyopathy (HCM) and disabling symptoms refractory to maximum medical management has historically been a surgical problem. Surgical septal myectomy permanently abolishes systolic anterior motion of the mitral valve and mitral regurgitation, while normalizing LV pressures and wall stress. Also, these salutary goals are achieved without encumbering patients with post-procedural devices (e.g., pacemakers or defibrillators) or creating potentially arrhythmogenic substrates, as may occur with alcohol septal ablation. Procedural morbidity and mortality risk with myectomy is similar to, and in some institutions less than those for alcohol septal ablation. Over four decades, reports from numerous centers worldwide have consistently and unequivocably documented the benefits of surgery on hemodynamic and functional state, restoring normal and acceptable quality of life to patients of all ages by largely reversing the complications of heart failure. Long-term survival after myectomy is similar to that of the general population and superior to non-operated patients with obstruction. The LV outflow tract morphology in HCM is heterogeneous and not uncommonly includes congenital anomalies of the mitral valve apparatus for which the surgeon has the flexibility to adapt the repair, often employing an extended myectomy. In the current atmosphere of increasing and perhaps excessive enthusiasm for newer catheter-based interventions, it is a critical time to promote and re-emphasize that surgery is the time-honored (and presently the most effective) treatment strategy for relieving heart failure-related disability resulting from dynamic LV outflow obstruction in HCM, and is the primary treatment option for this subgroup of severely symptomatic drug-refractory patients.

show abstract

Section: Post-surgical Resultsmentioning

confidence: 51%

Section: Post-surgical Resultsmentioning

confidence: 99%

Section: Post-surgical Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The case for surgery in obstructive hypertrophic cardiomyopathy

Maron

Dearani

Ommen

et al. 2004

Journal of the American College of Cardiology

196

114

View full text Add to dashboard Cite

show abstract

“…At centers with extensive surgical experience in HCM, mortality is 1% to 3% [5••,16]. Preliminary studies suggest that myectomy operation may prolong survival [17]. Complications At experienced centers, complete atrioventricular block (~ 5% of patients); mild-to-moderate aortic regurgitation due to operative damage of the aortic cusps (~ 20%); septal defect (< 2%).…”

Section: Myectomy Operationmentioning

confidence: 99%

Approach to hypertrophic cardiomyopathy

Autore¹,

Spirito

2004

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Hypertrophic cardiomyopathy is a genetic disease characterized by marked left ventricular (LV) hypertrophy. A dynamic LV outflow obstruction is present in approximately 20% of patients. Many affected individuals remain asymptomatic throughout life, others develop heart failure symptoms or atrial fibrillation (AF), and some die suddenly, often young and in the absence of previous symptoms. Stratification of sudden death risk is based on several markers, including a previous cardiac arrest, sustained ventricular tachycardia, family history of sudden death, extreme LV hypertrophy (>/= 30 mm), syncope, nonsustained ventricular tachycardia on Holter, and abnormal exercise blood pressure response. The implantable cardioverter-defibrillator is the most effective treatment for sudden death prevention, and should be considered in patients with either one strong or multiple risk factors. Important symptoms of heart failure develop in a minority of patients, largely as a consequence of diastolic dysfunction, and are usually treated with beta blockers, or verapamil. In patients with LV obstruction and severe symptoms unresponsive to medications, myectomy operation or alcohol septal ablation is indicated for relieving the gradient and improving quality of life. AF develops in approximately 20% of patients. Amiodarone is the most effective medication for preventing AF recurrences. In chronic AF, beta blockers or verapamil are usually effective for heart rate control. The threshold for anticoagulants is low, because even brief AF episodes have a substantial embolization risk.

show abstract

“…Hypertrophic cardiomyopathy. Ommen et al (28), from the Mayo Clinic, examined the long-term effects of surgical myectomy in 1,337 patients evaluated between 1983 and 2001. This is the largest study examining this subject.…”

mentioning

confidence: 99%

Cardiac structure and function

Kushwaha

2004

Journal of the American College of Cardiology

View full text Add to dashboard Cite

839-1 The long-term effect of surgical myectomy on survival in patients with obstructive hypertrophic cardiomyopathy

Cited by 10 publications

References 0 publications

The case for surgery in obstructive hypertrophic cardiomyopathy

The case for surgery in obstructive hypertrophic cardiomyopathy

Approach to hypertrophic cardiomyopathy

Cardiac structure and function

Contact Info

Product

Resources

About