Short and Medium Term Outcomes of Surgery for Patients With Hypertrophic Obstructive Cardiomyopathy

Parry, Dominic; Raskin, Robert E.; Poynter, Jeffery A.; Ribero, Igo B.; Bajona, Pietro; Rakowski, Harry; Woo, Anna; Ralph-Edwards, Anthony

doi:10.1016/j.athoracsur.2014.11.020

Cited by 27 publications

(19 citation statements)

References 23 publications

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“…The rate of operative mortality was similar between groups (0/25 for historical cohort vs. 1/24 for recent cohort [p = 0.3]). Complications occurred in eight patients and included atrial fibrillation (7), need for pacemaker (2), and pneumonia (1). The rate of complications was similar between groups, as well (8/25 for historical cohort vs. 13/24 for recent cohort (p = 0.1).…”

Section: Comparison To Historical Cohortmentioning

confidence: 79%

“…In a report by the Mayo Clinic, eight of 32 patients with HOCM and mitral valve disease required a second aortic cross clamping period to address the mitral valve . Lastly, in another large series, Parry et al reported that seven of 211 patients required a second aortic‐cross clamping to address SAM and LVOT obstruction . Thus, although septal myectomy is safe and effective in the majority of patients, adverse events related to MR, SAM, and LVOT obstruction do occur and warrant attention.…”

Section: Discussionmentioning

confidence: 99%

“…Septal myectomy is the gold standard therapy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) refractory to optimal medical therapy . The procedure is typically performed via a trans‐aortic approach and is associated with excellent outcomes . HOCM patients, in addition to having left ventricular outflow tract obstruction (LVOT) from hypertrophied myocardium, often have an abnormal mitral valve and mitral valve apparatus.…”

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confidence: 99%

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Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy

2016

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Section: Comparison To Historical Cohortmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy

2016

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“…In a recent review of consecutive patients receiving operations over a 10-year period at the Toronto General Hospital, we have found that the vast majority of patients with isolated outflow tract obstruction or mixed outflow tract and mid-cavitary obstruction obtain excellent results with a Morrow type resection including extension under the membranous septum. In dedicated HOCM centres, mortality is typically less than 1% for isolated myectomies and is associated with excellent long-term survival (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Transaortic septal myectomy: techniques and pitfalls

Ralph-Edwards¹,

Vanderlaan²,

Bajona³

2017

Ann. Cardiothorac. Surg.

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Hypertrophic cardiomyopathy (HCM) is the most common congenital cardiac disease, affecting up to 1 in 200 individuals. When it causes left ventricular outflow tract (LVOT) obstruction, treatment is indicated to reduce symptoms and the risk of sudden cardiac death. Pharmacologic therapy is the first line treatment, however if it fails, surgical myectomy or percutaneous ablation of the hypertrophic myocardium are the standard therapies to eliminate subaortic obstruction. Both surgical myectomy and percutaneous ablation have been demonstrated as safe and effective treatments; however, myectomy is the gold standard with a significantly lower complication rate and more complete and longstanding reduction of LVOT obstruction.

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“…In dedicated HOCM centres, mortality is typically less than 1% for isolated myectomies and is associated with excellent long-term survival (1,(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

Vanderlaan

Woo

Ralph-Edwards

2017

Ann. Cardiothorac. Surg.

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Background: Isolated septal myectomy is considered the gold standard for refractory left ventricular outflow tract (LVOT) obstruction at centers with dedicated hypertrophic obstructive cardiomyopathy (HOCM) surgeons. In this paper, we provide an update on the Toronto General Hospital (TGH) experience for isolated septal myectomy and comment on the safety and efficacy of myectomy in patients with thin basal septal thickness at our institution. Methods:We retrospectively reviewed all patients undergoing surgical myectomy at our institution from January 2012 to August 2016. We analyzed patient characteristics, intraoperative variables, pre-and postprocedural echocardiographic parameters, and key outcomes including post-operative stroke, renal failure, iatrogenic ventricular septal defect (VSD), post-procedure insertion of permanent pacemaker, and mortality.Results: At our institution, 150 isolated septal myectomy surgeries were performed over the study period.Preoperative echocardiography demonstrated an average basal septal thickness of 2.10±0.43 cm with a resting gradient of 67±37 mmHg and a provoked gradient of 89±40 mmHg. Fifty percent of patients had significant systolic anterior motion (SAM) of their mitral valve and 53% had associated moderate to severe mitral regurgitation (MR). Of note, 24% of patients had a thin septum of ≤1.7 cm. Discharge echocardiograms demonstrated significant septal reduction to an average basal septal thickness of 1.04±0.26 (P<0.05), with negligible resting and provokable LVOT gradients. At the time of discharge, none of the patients had significant SAM and only 5.3% of patients had residual greater than mild MR. Patients undergoing isolated myectomy with a thin basal septum had similar outcomes to those with a >1.7 cm septal thickness. In our contemporary cohort, there were no iatrogenic VSDs, 5.3% of patients required a permanent pacemaker and there was one early death.Conclusions: Our cohort demonstrates that isolated septal myectomy remains a safe and effective operation that can achieve excellent results, irrespective of basal septal thickness, when done by experienced surgeons in a dedicated hypertrophic cardiomyopathy (HCM) center.

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Short and Medium Term Outcomes of Surgery for Patients With Hypertrophic Obstructive Cardiomyopathy

Cited by 27 publications

References 23 publications

Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy

Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy

Transaortic septal myectomy: techniques and pitfalls

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

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