Surgical septal myectomy for hypertrophic cardiomyopathy. The Iranian experience

Abstract

Introduction Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary heart muscle disorder characterized by significant myocardial hypertrophy. we assessed perioperative and long-term follow-up data of Iranian HOCM patients who underwent SM in 2 pioneering centers. Methods Clinical data of patients with HOCM septal myectomy are collected. Thirty-day outcome and long-term follow-up data for recurrence of gradient and mortality are reported. Results Ninety-six patients in two different centers enrolled in the study. Most patients of 52 patients in center 1 were male (34/52 [65.3%]).and the mean age was of 36.7 ± 19 years. Syncope before admission was reported in 5.7%, the mean left ventricular ejection fraction on admission was 53 ± 8%, the mean left ventricular outflow tract gradient was 66.3 ± 20.4 mm Hg, and the mean preoperativeseptal thickness was 25.4 ± 6.7 mm. A redo SM was performed in 3 patients (5.8%), mitral valve repair in 5 patients (9.6%), and atrioventricular repair in 5 patients (9.6%). A residual systolic anterior motion was detected in 4 patients (7.7%), the mean postoperative septal thickness was 19 ± 6 mm (25.1% septal thickness reduction), and in-hospital mortality was 5.8% (n = 3). A longer-term follow-up showed death in 3 patients (5.8%) and late recurrent left ventricular outflow tract obstruction in 1 patient. Conclusions Transaortic myectomy is an effective surgery with acceptable early and late mortality rates. Improvements in functional status are seen in almost all patients. Appropriate SM is crucial to a good clinical outcome. Long-term survival is excellent and cardiac sudden death is extremely rare after a good surgical treatment.

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

“…The average age of our patients was similar to previous reports from Western countries 28,30,34 . However, the average age in several other studies was relatively lower, possibly due to the inclusion of patients with congenital septal abnormalities 19,35 …”

“…28,30,34 However, the average age in several other studies was relatively lower, possibly due to the inclusion of patients with congenital septal abnormalities. 19,35 Baseline echocardiographic characteristics of our patients indicated a significantly increased IVS and LVOT gradient in these patients (21.5 ± 5.8) accompanied by a normal EF in HCM patients. 71% of the patients had a detectable SAM before the surgery (65% had moderate or higher), and 72.6% of the patients had a moderate or higher MR, which was significantly corrected regardless of the type of surgery, except in one case where significant residual SAM was detected after the surgery.…”

“…There are sparse data on the surgical treatment status for HCM patients in Iran. A recent study by Ghavidel et al estimated that only 30 septal myectomy procedures are performed annually for Iranian HCM patients 19 . This indicates that a large number of HCM patients who might benefit from surgical interventions are not receiving appropriate interventions.…”

“…The septal myectomy continued with an up‐and‐down movement of the surgical blade in a counterclockwise route toward the commissure between the left and right aortic cusps, extending toward the papillary muscles 10 . The white fibrotic scar on the involved septum typically served as a marker for the extension of myectomy if present 19 . The depth of myectomy was determined based on echocardiographic and surgical findings and the surgeon's experience.…”

Hypertrophic Obstructive Cardiomyopathy Repair with Coronary Artery Bypass Surgery: A Case Report

“…Many studies talk about surgical myectomy in (HOCM) patients to improve symptoms, in Alireza et al (9) study that conducted on Ninety-six patients treated with trans-aortic myectomy with acceptable early and late mortality rates. Improvements in functional status are seen in almost all patient's Long-term survival is excellent and cardiac sudden death is extremely rare after a good surgical treatment.…”