Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy in the Elderly

Wong, Lye-Yeng; Alver, Naima; Dewey, Elizabeth; Bhamidipati, Castigliano M.; Lantz, Gurion; Tibayan, Frederick A.; Heitner, Stephen B.; Masri, Ahmad; Song, Howard K.

doi:10.1016/j.athoracsur.2021.05.058

Cited by 12 publications

(8 citation statements)

References 16 publications

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“…First, we found that the all-cause mortality after SM (2.1%) was higher than prior reports from single center-high volume experiences, where low postoperative mortality (<1%) 5,9–12 is described, and similar to the volume-unadjusted report from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. 13 We report a post-ASA mortality rate of 1.3%, which is similar to prior reports from the Mayo Clinic (1.4%) 14 and higher than studies from the Euro-Alcohol Septal Ablation Registry (0.6%).…”

Section: Discussionsupporting

confidence: 66%

In-hospital outcomes of septal myectomy vs. alcohol septal ablation for hypertrophic cardiomyopathy with outflow tract obstruction: An update and insights from the national inpatient sample from 2011 to 2019

Inestroza,

Mijares-Rojas,

Matute-Martínez

et al. 2024

Journal of Investigative Medicine

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Septal Myectomy (SM) and Alcohol Septal Ablation (ASA) improve symptoms in patients with Hypertrophic Cardiomyopathy with outflow tract obstruction (oHCM). However, outcomes data in this population is predominantly from specialized centers. The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with oHCM who underwent SM vs. ASA. A p-value <0.001 was considered statistically significant. We identified 15,119 patients with oHCM who underwent septal reduction therapies, of whom 57.4% underwent SM, and 42.6% underwent ASA. Patients who underwent SM had higher all-cause mortality (OR:1.8 [1.3-2.5]), post-procedure ischemic stroke (OR: 2.3 [1.7-3.2]), acute kidney injury (OR: 1.4 [1.2-1.7]), vascular complications (OR: 3.6 [2.3-5.3]), ventricular septal defect (OR: 4.4 [3.2-6.1]), cardiogenic shock (OR: 1.7 [1.3-2.3]), sepsis (OR: 3.2 [1.9-5.4]), and left bundle branch block (OR: 3.5 [3-4]), compared to ASA. Patients who underwent ASA had higher post-procedure complete heart block (OR: 1.3 [1.1-1.4]), right bundle branch block (OR: 6.3 [5-7.7]), ventricular tachycardia (OR:2.2 [1.9-2.6]), supraventricular tachycardia (OR: 1.6 [1.4-2]), and more commonly required pacemaker insertion (OR: 1.4 [1.3-1.7]) (p<0.001 for all) compared to SM. This nationwide analysis evidenced that patients undergoing SM had higher in-hospital mortality and periprocedural complications than ASA; however, those undergoing ASA had more post-procedure conduction abnormalities and pacemaker implantation. The implications of these findings warrant further investigation regarding patient selection strategies for these therapies.

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Section: Discussionsupporting

confidence: 66%

In-hospital outcomes of septal myectomy vs. alcohol septal ablation for hypertrophic cardiomyopathy with outflow tract obstruction: An update and insights from the national inpatient sample from 2011 to 2019

Inestroza,

Mijares-Rojas,

Matute-Martínez

et al. 2024

Journal of Investigative Medicine

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“…This improvement can be attributed to several factors, including reduced backflow to the left atrium due to LVOT obstruction relief, 36 improved coaptation of MV leaflets, 37 which is disrupted in HCM patients due to asymmetric hypertrophy and LVOT obstruction, and reduced mechanical stress on the MV and its supporting structures. 38 Moreover, postoperative echocardiograms indicated acceptable LVOT gradient and IVS reductions in all three groups. Although patients receiving a septal myectomy procedure had the most significant reduction in LVOT gradient, MVR was also associated with a relative decrease in LVOT gradient, which can be attributed to the Normalization of LV Geometry, 39 improved blood flow dynamics, 40 and a reduction in Valve-Septum Contact.…”

Section: Discussionmentioning

confidence: 80%

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Ayati,

Khoshfetrat,

Davoodi

et al. 2024

Health Science Reports

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BackgroundHypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life‐threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long‐term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries.MethodsThis was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in‐hospital and long‐term outcomes were reported and compared between the three groups.ResultsA total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty‐six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8‐year follow‐up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups.ConclusionIsolated septal myectomy showed better long‐term survival rates and can correct HCM‐related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM.

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“…Data from these centers is replete with evidence of salutary short-term and long-term benefit following myectomy in adults of all ages including the elderly [100][101][102] and also children [103][104][105] i.e., abolition of SAM and relief of peak resting or provocable outflow obstruction and mitral regurgitation that is immediate, complete and permanent (nonrecurring) with preoperative gradients reduced from ≥50 mmHg (and up to ≥ 100mmHg) to zero or negligible (<10 mmHg) post-operatively [2][3][4][5][6][7][8][9]11,72,90,97,98,106 (Figure 5). Significant residual gradients requiring reoperation are rare (about 2% in experienced centers), 107 usually attributable to inadequate length of muscular septal excision.…”

Section: Clinical Results Of Surgical Myectomymentioning

confidence: 99%

“…ASA is usually reserved for older patients and/or those with significant co-morbidities, or when myectomy is judged to present an unacceptable risk, or is not available. 124 Unlike myectomy, which can be performed at virtually any age or LV wall thickness, 75,80,[100][101][102][103][104][105] ASA is discouraged <40 years of age, <18mm wall thickness, and excluded in patients <20 years.…”

Section: Alcohol Septal Ablationmentioning

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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Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy in the Elderly

Cited by 12 publications

References 16 publications

In-hospital outcomes of septal myectomy vs. alcohol septal ablation for hypertrophic cardiomyopathy with outflow tract obstruction: An update and insights from the national inpatient sample from 2011 to 2019

In-hospital outcomes of septal myectomy vs. alcohol septal ablation for hypertrophic cardiomyopathy with outflow tract obstruction: An update and insights from the national inpatient sample from 2011 to 2019

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

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

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