Surgical treatment of hypertrophic cardiomyopathy: what’s new?

Abstract

The aim — to investigate the effectiveness of surgical septal myectomy in patients with obstructive form of hypertrophic cardiomyopathy (HCM) and to determine its effect on survival and quality of life.Materials and methods. The research included 118 consequential symptomatic patients with obstructive form of HCM who underwent surgical extensive myectomy with secondary chordae resection and mobilization of the anterior and posterior groups of papillary muscles (PM). An evaluation of the following parameters in group of patients before and after surgical intervention was performed: systolic pressure gradient (SPG) on the left ventricle outflow tract (LVOT), mitral regurgitation (MR) degree, NYHA functional class, survival rate and main post­operative complications.Results and discussion. According to the obtained data, SPG decreased from 93.6 ± 23.2 mmHg prior the surgery to 19.7 ± 11.4 mmHg after the treatment (p < 0.001). 21 (17.8 %) patients had moderate degree of MR after the surgery, while before the intervention the number of patients who had moderate or severe MR degree made up 101 (85.5 %) out of 118 (p < 0.001). Out of 118 patients, 36 (30.5 %) of whom had III — IV NYHA functional class of heart failure before the procedure, 115 (97.4 %) switched to functional class I — II in the latest follow­up (p < 0.001). The mortality accounted for 1.7 %. Out of 118 patients under study, one (0.8 %) underwent cardioverter­defibrillator implantation in the post­operative period for the prophilaxis of sudden death, and 5 (4.2 %) patients underwent pacemaker implantation due to complete post­operative AV­block.Conclusions. Surgical septal myectomy by professor P. Ferrazzi procedure is a gold standard of treatment of patients with obstructive form of HCM. Successful correction of HCM can be conducted only by a high­qualified surgeon with experience of reconstruction of valvular pathologies and in an expert center, where it is possible to perform routine pre­operative MRI or CT‑planning and mandatory intraoperative echocardiographic control.