Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures

Pruna-Guillen, Robert; Pereda, Daniel; Castellà, Manuel; Sandoval, Elena; Affronti, Alessandro; García‐Álvarez, Ana; Perdomo, Juan; Ibáñez, Cristina; Jordà, Paloma; Prat‐González, Susanna; Alcocer, Jorge; Barriuso, Clemente; Llopis, Jaume

doi:10.3390/jcm10163499

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Preoperatively, the majority of our subjects (59%) were either in NYHA class III or IV, with a mean IVS thickness of 24 ± 6 mm and a mean LVOT gradient of 93 ± 33 mmHg. In addition, postoperative outcomes at hospital discharge are in line with those observed in other surgical cohorts, with significant reduction in peak resting/provoked intraventricular gradient and significant improvement in heart failure symptoms [ 11 , 13 , 14 ]. A postoperative residual gradient of >30 mmHg was noticed in only 5 (6%) patients, consistent with literature data [ 14 , 15 ].…”

Section: Discussionsupporting

confidence: 76%

“…In addition, postoperative outcomes at hospital discharge are in line with those observed in other surgical cohorts, with significant reduction in peak resting/provoked intraventricular gradient and significant improvement in heart failure symptoms [ 11 , 13 , 14 ]. A postoperative residual gradient of >30 mmHg was noticed in only 5 (6%) patients, consistent with literature data [ 14 , 15 ]. Notably, recent evidence from other groups, as well as our unpublished preliminary data, showed sustained improvement in hemodynamic and functional status during long-term follow-up [ 16 ].…”

Section: Discussionsupporting

confidence: 76%

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Transaortic Shallow Septal Myectomy and Cutting of Secondary Fibrotic Mitral Valve Chordae—A 5-Year Single-Center Experience in the Treatment of Hypertrophic Obstructive Cardiomyopathy

Dorobantu

Iosifescu

Ticulescu

et al. 2022

JCM

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Background: Anomalies of the mitral apparatus have been shown to contribute to left ventricular outflow obstruction in patients with hypertrophic cardiomyopathy (HCM). We report our 5-year single-center experience with a shallow myectomy procedure associated with transaortic mitral valve repair in a cohort of HCM patients. Methods: We studied 83 consecutive patients who underwent surgical treatment of symptomatic left ventricular outflow obstruction. In all study patients, a transaortic shallow septal myectomy was performed. Fibrous or muscular structures connecting the papillary muscles to the septum or free wall were resected, and fibrotic secondary chordae of the anterior mitral valve were cut selectively. Results: We report one death (1.2%) during hospitalization, no iatrogenic ventricular septal defects, and two (2.4%) mitral valve replacements. At discharge, no patients were in New York Heart Association (NYHA) Class III/IV, from 49 (59%) preoperatively. Mean maximal septal thickness decreased from 24 ± 6 to 16 ± 3 mm. Mean outflow gradient decreased from 93 ± 33 to 13 ± 11 mmHg. Grade 3 or 4 mitral regurgitation was noticed in one patient postoperatively, from 32 (39%) before surgery. Conclusions: Shallow septal myectomy associated with secondary mitral valve chordal cutting and papillary muscle mobilization provided excellent results offering adequate treatment of outflow obstruction.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 76%

Transaortic Shallow Septal Myectomy and Cutting of Secondary Fibrotic Mitral Valve Chordae—A 5-Year Single-Center Experience in the Treatment of Hypertrophic Obstructive Cardiomyopathy

Dorobantu

Iosifescu

Ticulescu

et al. 2022

JCM

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“…Apart from similar mortality rates, older patients were more likely to undergo concomitant coronary artery bypass. Pruna-Guillen et al ( 16 ) showed that SM is an effective and safe procedure for elderly patients despite the need for concomitant procedures. In this series, the in-hospital mortality rate was 1.9% ( n = 1) and 84.6% of the enrolled patients underwent concomitant procedures, including aortic valve replacement, coronary surgery, and Maze procedure.…”

Section: Discussionmentioning

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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“…Details of the operation have been widely described previously by our mentors 25,26 with some additional left ventricular interventions if felt valuable to address certain HCM phenotypes as described in our experience by Pruna. 27 There are many other factors that play a role in the difficulty of the operation such as obesity, depth of patient chest, small aortic annuli, aortic root/valve rigidity, septal tissue consistency (presence of fibrosis or prior alcohol ablation) and also septal-to-floor angle.…”

Section: Insights Into the Operation And The Minimal Necessary Instru...mentioning

confidence: 99%

The first 200 septal myectomies: Ensuring gold standard outcomes

Bajona

2021

Asian Cardiovasc Thorac Ann

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Objectives Septal myectomy remains the gold standard treatment for symptomatic left ventricular outflow tract obstruction refractory to medical treatment. It is recommended that this operation be performed in dedicated hypertrophic obstructive cardiomyopathy centres by experienced surgeons. The septal myectomy option remains unavailable to many patients based solely on geography, including those who would clearly benefit more substantially from surgery than other therapeutic options. Here, we share our experience in starting new hypertrophic cardiomyopathy programmes. Methods We retrospectively reviewed initial septal myectomy experiences at two hypertrophic cardiomyopathy programmes starting in 2014. Results Two-hundred septal myectomies were performed. Mean age was 58.8 years and 51% were females. Advanced heart failure symptoms were present in 95.5% of patients and 23.5% had experienced syncope. Mean maximal intraventricular gradient was 89 mmHg and 48.5% underwent concomitant procedures at the time of septal myectomy. There was no perioperative (in-hospital or 30 days) mortality. Ninety-two per cent had provoked left ventricular gradients of ≤ 15 mmHg and 97% had none/mild mitral regurgitation at post-operative assessment. In our contemporary cohort, there were 2 (1%) intraoperative ventricular septal defects and 5% required a permanent pacemaker. Conclusions Our early septal myectomy experience targeted a complex population, frequently in need of concomitant procedures. Abolition of left ventricular obstruction and resolution of systolic anterior motion mediated mitral regurgitation can be expected. The safety and efficacy of septal myectomy carried at hypertrophic cardiomyopathy centres by properly trained surgeons achieved the desired outcomes established by recent hypertrophic cardiomyopathy guidelines.

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Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures

Cited by 8 publications

References 26 publications

Transaortic Shallow Septal Myectomy and Cutting of Secondary Fibrotic Mitral Valve Chordae—A 5-Year Single-Center Experience in the Treatment of Hypertrophic Obstructive Cardiomyopathy

Transaortic Shallow Septal Myectomy and Cutting of Secondary Fibrotic Mitral Valve Chordae—A 5-Year Single-Center Experience in the Treatment of Hypertrophic Obstructive Cardiomyopathy

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

The first 200 septal myectomies: Ensuring gold standard outcomes

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