Concomitant septal myectomy in patients undergoing aortic valve replacement for severe aortic stenosis

Ju Yong Lim, Jin Oh Choi, Oh Jae Kon, Zhou Li, Soon J. Park

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Patients with severe aortic stenosis (AS) are often found to have asymmetric septal hypertrophy (ASH). With low sensitivity of echocardiography for detecting dynamic left ventricular outflow tract (LVOT) obstruction in severe AS, we adopted a routine intraoperative inspection of LVOT strategy for aortic valve replacement (AVR), and performed concomitant septal myectomy (CSM) as necessary. We sought to (1) evaluate surgical outcomes of CSM, (2) suggest preoperative echocardiographic parameters that correlate with findings of ASH, and (3) determine the predictors of CSM.

Methods and Results: A single surgeon performed AVR for moderate-to-severe AS in 301 patients from 2007 to 2012. CSM was performed in 35 (11.6%) patients, resulting in AVR vs. AVR+CSM groups. Echocardiographic parameters, including the ratio of LVOT to aortic annular diameter (LVOT/AA), were compared. Mortality rate was comparable between groups (P=0.37). There were no postoperative complications related to CSM. The AVR+CSM group had a smaller LVOT/AA ratio (P=0.0012). The predictor of CSM was implanted valve size ≤21 mm (odds ratio 3.2, confidence interval 1.54–6.65, P=0.002).

Conclusions: CSM can be performed safely at the time of AVR. The preoperative echocardiographic LVOT/AA ratio may help in detecting ASH. As an implanted valve size ≤21 mm was the only risk factor for CSM, careful assessment of LVOT is important in patients with a small aortic annulus.

Original languageEnglish (US)
Pages (from-to)375-380
Number of pages6
JournalCirculation Journal
Volume79
Issue number2
DOIs
StatePublished - Jan 16 2015

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Aortic Valve Stenosis
Aortic Valve
Hypertrophy
Ventricular Outflow Obstruction
Echocardiography
Odds Ratio
Confidence Intervals
Mortality

Keywords

  • Aortic valve replacement
  • Hypertrophic cardiomyopathy
  • Septal myectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Concomitant septal myectomy in patients undergoing aortic valve replacement for severe aortic stenosis. / Yong Lim, Ju; Choi, Jin Oh; Jae Kon, Oh; Li, Zhou; Park, Soon J.

In: Circulation Journal, Vol. 79, No. 2, 16.01.2015, p. 375-380.

Research output: Contribution to journalArticle

Yong Lim, Ju ; Choi, Jin Oh ; Jae Kon, Oh ; Li, Zhou ; Park, Soon J. / Concomitant septal myectomy in patients undergoing aortic valve replacement for severe aortic stenosis. In: Circulation Journal. 2015 ; Vol. 79, No. 2. pp. 375-380.
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abstract = "Background: Patients with severe aortic stenosis (AS) are often found to have asymmetric septal hypertrophy (ASH). With low sensitivity of echocardiography for detecting dynamic left ventricular outflow tract (LVOT) obstruction in severe AS, we adopted a routine intraoperative inspection of LVOT strategy for aortic valve replacement (AVR), and performed concomitant septal myectomy (CSM) as necessary. We sought to (1) evaluate surgical outcomes of CSM, (2) suggest preoperative echocardiographic parameters that correlate with findings of ASH, and (3) determine the predictors of CSM.Methods and Results: A single surgeon performed AVR for moderate-to-severe AS in 301 patients from 2007 to 2012. CSM was performed in 35 (11.6{\%}) patients, resulting in AVR vs. AVR+CSM groups. Echocardiographic parameters, including the ratio of LVOT to aortic annular diameter (LVOT/AA), were compared. Mortality rate was comparable between groups (P=0.37). There were no postoperative complications related to CSM. The AVR+CSM group had a smaller LVOT/AA ratio (P=0.0012). The predictor of CSM was implanted valve size ≤21 mm (odds ratio 3.2, confidence interval 1.54–6.65, P=0.002).Conclusions: CSM can be performed safely at the time of AVR. The preoperative echocardiographic LVOT/AA ratio may help in detecting ASH. As an implanted valve size ≤21 mm was the only risk factor for CSM, careful assessment of LVOT is important in patients with a small aortic annulus.",
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N2 - Background: Patients with severe aortic stenosis (AS) are often found to have asymmetric septal hypertrophy (ASH). With low sensitivity of echocardiography for detecting dynamic left ventricular outflow tract (LVOT) obstruction in severe AS, we adopted a routine intraoperative inspection of LVOT strategy for aortic valve replacement (AVR), and performed concomitant septal myectomy (CSM) as necessary. We sought to (1) evaluate surgical outcomes of CSM, (2) suggest preoperative echocardiographic parameters that correlate with findings of ASH, and (3) determine the predictors of CSM.Methods and Results: A single surgeon performed AVR for moderate-to-severe AS in 301 patients from 2007 to 2012. CSM was performed in 35 (11.6%) patients, resulting in AVR vs. AVR+CSM groups. Echocardiographic parameters, including the ratio of LVOT to aortic annular diameter (LVOT/AA), were compared. Mortality rate was comparable between groups (P=0.37). There were no postoperative complications related to CSM. The AVR+CSM group had a smaller LVOT/AA ratio (P=0.0012). The predictor of CSM was implanted valve size ≤21 mm (odds ratio 3.2, confidence interval 1.54–6.65, P=0.002).Conclusions: CSM can be performed safely at the time of AVR. The preoperative echocardiographic LVOT/AA ratio may help in detecting ASH. As an implanted valve size ≤21 mm was the only risk factor for CSM, careful assessment of LVOT is important in patients with a small aortic annulus.

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