TY - JOUR
T1 - Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure
AU - Nguyen, Anita
AU - Schaff, Hartzell V.
AU - Nishimura, Rick A.
AU - Geske, Jeffrey B.
AU - Dearani, Joseph A.
AU - King, Katherine S.
AU - Ommen, Steve R.
N1 - Publisher Copyright:
© 2019 The American Association for Thoracic Surgery
PY - 2020/1
Y1 - 2020/1
N2 - Objective: In patients with apical hypertrophic cardiomyopathy, extensive apical hypertrophy may reduce left ventricular end-diastolic volume and contribute to diastolic dysfunction, angina, and ventricular arrhythmias. Transapical myectomy to augment left ventricular cavity size can increase stroke volume and decrease left ventricular end-diastolic pressure. In this study, we describe early outcomes of patients with apical hypertrophic cardiomyopathy after transapical myectomy and compare survival with that of patients with hypertrophic cardiomyopathy listed for heart transplantation. Methods: Between September 1993 and March 2017, 113 symptomatic patients with apical hypertrophic cardiomyopathy underwent transapical myectomy. Clinical information, echocardiographic data, and follow-up were reviewed. With the use of a national database, survival was compared with that of patients with hypertrophic cardiomyopathy listed for heart transplantation. Results: In the surgical cohort, median (interquartile range) age was 50.8 (39.3-60.7) years, and 49 (43%) were male. Preoperatively, 108 patients (96%) were in New York Heart Association class III/IV. All patients underwent transapical myectomy. There were 4 (4%) deaths within 30 days of operation. At last follow-up, 76% of patients reported improvement in symptoms, and 3 patients (3%) subsequently underwent cardiac transplantation for recurrent heart failure. The estimated 1-, 5-, and 10-year survivals were 96%, 87%, and 74%, respectively. Survival appeared superior to patients with hypertrophic cardiomyopathy listed for heart transplant. Conclusions: Apical myectomy is beneficial in severely symptomatic patients with apical hypertrophic cardiomyopathy. Early risk of the procedure is low, and approximately 76% maintain clinical improvement with resolution of symptoms. Long-term survival appears better than for patients listed for heart transplantation.
AB - Objective: In patients with apical hypertrophic cardiomyopathy, extensive apical hypertrophy may reduce left ventricular end-diastolic volume and contribute to diastolic dysfunction, angina, and ventricular arrhythmias. Transapical myectomy to augment left ventricular cavity size can increase stroke volume and decrease left ventricular end-diastolic pressure. In this study, we describe early outcomes of patients with apical hypertrophic cardiomyopathy after transapical myectomy and compare survival with that of patients with hypertrophic cardiomyopathy listed for heart transplantation. Methods: Between September 1993 and March 2017, 113 symptomatic patients with apical hypertrophic cardiomyopathy underwent transapical myectomy. Clinical information, echocardiographic data, and follow-up were reviewed. With the use of a national database, survival was compared with that of patients with hypertrophic cardiomyopathy listed for heart transplantation. Results: In the surgical cohort, median (interquartile range) age was 50.8 (39.3-60.7) years, and 49 (43%) were male. Preoperatively, 108 patients (96%) were in New York Heart Association class III/IV. All patients underwent transapical myectomy. There were 4 (4%) deaths within 30 days of operation. At last follow-up, 76% of patients reported improvement in symptoms, and 3 patients (3%) subsequently underwent cardiac transplantation for recurrent heart failure. The estimated 1-, 5-, and 10-year survivals were 96%, 87%, and 74%, respectively. Survival appeared superior to patients with hypertrophic cardiomyopathy listed for heart transplant. Conclusions: Apical myectomy is beneficial in severely symptomatic patients with apical hypertrophic cardiomyopathy. Early risk of the procedure is low, and approximately 76% maintain clinical improvement with resolution of symptoms. Long-term survival appears better than for patients listed for heart transplantation.
KW - apical
KW - hypertrophic cardiomyopathy
KW - myectomy
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U2 - 10.1016/j.jtcvs.2019.03.088
DO - 10.1016/j.jtcvs.2019.03.088
M3 - Article
C2 - 31053431
AN - SCOPUS:85064940988
SN - 0022-5223
VL - 159
SP - 145
EP - 152
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -