Surgery for hypertrophic cardiomyopathy

Wu, James J.; Seco, Michael; Medi, Caroline; Semsarian, C.; Richmond, David; Dearani, Joseph A.; Schaff, Hartzell V.; Byrom, Michael; Bannon, Paul G.

doi:10.1007/s12551-014-0153-3

Cited by 11 publications

(3 citation statements)

References 61 publications

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“…3 Various accesses to reach and resect the hypertrophied myocardium to dilate the LVOT are described in the literature. 4,5 Transmitral access seems to be very suitable for septal myectomy particularly when mitral surgery is necessary. However, minimally invasive transmitral septal myectomy combined with MV surgery through right anterior mini-thoracotomy (RAMT) is rarely presented in the literature.…”

Section: Introductionmentioning

confidence: 99%

Transmitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy

Ahmad

Salamate

Giammarino

et al. 2022

Thorac Cardiovasc Surg

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Background Transmitral myectomy for symptomatic hypertrophic obstructive cardiomyopathy is possible with existence of substantial mitral valve disease. We present herein our experience of minimally invasive transmitral septal myectomy combined with mitral valve surgery through right anterior mini-thoracotomy in the past 4 years at our institution. Methods Between March 2017 and October 2020, 14 patients with hypertrophic obstructive cardiomyopathy and mitral valve disease required minimally invasive transmitral septal myectomy combined with mitral valve reconstruction or replacement at our institution. Mean age of patients was 54.2 ± 11.4 and 42.9% (n = 6) were female. Twelve patients (85.1%) were in New York Heart Association class III to IV and 6 patients (42.9%) presented with persistent atrial fibrillation. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 140.2 ± 32.6 minutes and the myocardial ischemic time was 78.5 ± 12.4 minutes. Thirty-day mortality and overall mortality were zero. Peak ventricular outflow gradient decreased from 75.2 ± 12.7 to 9.4 ± 2.3 mm Hg (p < 0.0001). Simultaneously, mitral valve reconstruction and replacement were performed in 11 (78.6%) and 3 (21.4%) patients, respectively. No systolic anterior motion was seen in patients with mitral valve repair. No conversion to full sternotomy and/or rethoracotomy was noted. During a mean follow-up period of 24 ± 13 months, no patient required reoperation, no recurrence mitral regurgitation, and left ventricular outflow tract obstruction. Conclusion Transmitral septal myectomy combined with mitral valve surgery through right anterior mini-thoracotomy can be performed safely with excellent surgical outcomes.

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Section: Introductionmentioning

confidence: 99%

Transmitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy

Ahmad

Salamate

Giammarino

et al. 2022

Thorac Cardiovasc Surg

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“…Recent studies of isolated septal myectomy report mortality rates up to 3%. 20 Four of the included studies reported early mortality rates below this. The two included studies with the highest mortality rates (6% 10 and 7% 17 ) reported mortality primarily due to respiratory failure and infection.…”

Section: Discussionmentioning

confidence: 98%

Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

Seco

Lau

Medi

et al. 2021

Asian Cardiovasc Thorac Ann

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Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

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“…12 Various pharmacologic agents may be used to reduce the LVOT gradient and risk of sudden death, such as β-blockers, verapamil, diltiazem and disopyramide (Figure 1). 10,13 Procedural therapies to alleviate LVOTO in drug refractory HOCM include either sequential dual chamber pacing with short atrioventricular delay or surgical reduction therapies such as septal myectomy or septal alcohol ablation. 14,15 Surgical myectomy has been performed since the 1950s with efficacy rates exceeding 90%.…”

Section: Factors Influencing Hocmmentioning

confidence: 99%

Post-operative management of hypertrophic obstructive cardiomyopathy

Mitra

Ramanathan

MacLaren

2022

Asian Cardiovasc Thorac Ann

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Hypertrophic obstructive cardiomyopathy patients are at increased risk of sudden cardiac arrest due to dynamic left ventricular outflow tract obstruction, myocardial ischaemia and arrhythmias. Septal myectomy remains the gold standard therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) refractory to other therapy. This review comprehensively focuses on the post-operative management and complications of HOCM patients undergoing surgical correction. Although these patients are at risk of various perioperative complications from anaesthesia and surgery due to the underlying complexity of their disease, surgical myectomy is associated with excellent long-term outcomes if carried out in experienced centers.

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Surgery for hypertrophic cardiomyopathy

Cited by 11 publications

References 61 publications

Transmitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy

Transmitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy

Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

Post-operative management of hypertrophic obstructive cardiomyopathy

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