Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure

Anita Nguyen, Hartzell V Schaff, Rick A. Nishimura, Jeffrey B. Geske, Joseph A. Dearani, Katherine S. King, Steve R. Ommen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hypertrophic Cardiomyopathy
Heart Failure
Heart Transplantation
Survival
Stroke Volume
Ventricular Dysfunction
Hypertrophy
Cardiac Arrhythmias
Databases
Blood Pressure

Keywords

  • apical
  • hypertrophic cardiomyopathy
  • myectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure. / Nguyen, Anita; Schaff, Hartzell V; Nishimura, Rick A.; Geske, Jeffrey B.; Dearani, Joseph A.; King, Katherine S.; Ommen, Steve R.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Nguyen, Anita ; Schaff, Hartzell V ; Nishimura, Rick A. ; Geske, Jeffrey B. ; Dearani, Joseph A. ; King, Katherine S. ; Ommen, Steve R. / Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure. In: Journal of Thoracic and Cardiovascular Surgery. 2019.
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abstract = "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.",
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