Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy?

Anita Nguyen, Hartzell V Schaff, Rick A. Nishimura, Joseph A. Dearani, Jeffrey B. Geske, Brian D. Lahr, Steve R. Ommen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVES: Patients with hypertrophic obstructive cardiomyopathy and basal septal thickness <18mm are often considered unsuitable candidates for myectomy. Mitral valve (MV) replacement is frequently performed instead. We aimed to determine whether septal thickness affects outcomes and adequacy of myectomy. METHODS: Clinical and echocardiographic data were reviewed for 1486 consecutive adult patients with hypertrophic obstructive cardiomyopathy who underwent transaortic septal myectomy from January 2005 through December 2014. Comparisons between patients, grouped by septal thickness (<18 mm, n = 369; 18-21 mm, n = 612 and >21 mm, n = 505), were performed with the Kruskal-Wallis and the Pearson χ2 tests and semiparametric analysis of covariance. RESULTS: Median group ages were 57, 57 and 54 years (P = 0.007); men comprised 50.4%, 56.7% and 62.0%, respectively (P = 0.003). Intrinsic MV disease was present in 5.9%, 5.2% and 4.6%, respectively (P = 0.80). All patients underwent transaortic septal myectomy. Additional mitral procedures were performed in 7.6%, 7.8% and 8.1%, respectively (P = 0.90). Reasons for MV surgery included intrinsic MV disease (66.7%), residual mitral regurgitation (30.8%) and residual gradient (2.6%). All groups had postoperative gradient relief (median reduction: 51, 54 and 50 mmHg; P = 0.11). Ventricular septal defect occurred in 4 patients (0.3%), and risk did not differ by group (P = 0.24). CONCLUSIONS: Adequate relief of left ventricular outflow tract obstruction can be achieved via transaortic septal myectomy without concomitant MV procedures when septal thickness is < 18 mm, and the risk of ventricular septal defect is minimal. Concomitant MV repair/replacement should be reserved for patients with intrinsic MV disease or inadequate relief of mitral regurgitation/left ventricular outflow tract obstruction following adequate extended septal myectomy.

Original languageEnglish (US)
Pages (from-to)582-589
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume53
Issue number3
DOIs
StatePublished - Mar 1 2018

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Hypertrophic Cardiomyopathy
Ventricular Outflow Obstruction
Ventricular Heart Septal Defects
Mitral Valve Insufficiency
Age Groups

Keywords

  • Hypertrophic cardiomyopathy
  • Mitral valve
  • Myectomy
  • Septal thickness

ASJC Scopus subject areas

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

Cite this

Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy? / Nguyen, Anita; Schaff, Hartzell V; Nishimura, Rick A.; Dearani, Joseph A.; Geske, Jeffrey B.; Lahr, Brian D.; Ommen, Steve R.

In: European Journal of Cardio-thoracic Surgery, Vol. 53, No. 3, 01.03.2018, p. 582-589.

Research output: Contribution to journalArticle

Nguyen, Anita ; Schaff, Hartzell V ; Nishimura, Rick A. ; Dearani, Joseph A. ; Geske, Jeffrey B. ; Lahr, Brian D. ; Ommen, Steve R. / Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy?. In: European Journal of Cardio-thoracic Surgery. 2018 ; Vol. 53, No. 3. pp. 582-589.
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abstract = "OBJECTIVES: Patients with hypertrophic obstructive cardiomyopathy and basal septal thickness <18mm are often considered unsuitable candidates for myectomy. Mitral valve (MV) replacement is frequently performed instead. We aimed to determine whether septal thickness affects outcomes and adequacy of myectomy. METHODS: Clinical and echocardiographic data were reviewed for 1486 consecutive adult patients with hypertrophic obstructive cardiomyopathy who underwent transaortic septal myectomy from January 2005 through December 2014. Comparisons between patients, grouped by septal thickness (<18 mm, n = 369; 18-21 mm, n = 612 and >21 mm, n = 505), were performed with the Kruskal-Wallis and the Pearson χ2 tests and semiparametric analysis of covariance. RESULTS: Median group ages were 57, 57 and 54 years (P = 0.007); men comprised 50.4{\%}, 56.7{\%} and 62.0{\%}, respectively (P = 0.003). Intrinsic MV disease was present in 5.9{\%}, 5.2{\%} and 4.6{\%}, respectively (P = 0.80). All patients underwent transaortic septal myectomy. Additional mitral procedures were performed in 7.6{\%}, 7.8{\%} and 8.1{\%}, respectively (P = 0.90). Reasons for MV surgery included intrinsic MV disease (66.7{\%}), residual mitral regurgitation (30.8{\%}) and residual gradient (2.6{\%}). All groups had postoperative gradient relief (median reduction: 51, 54 and 50 mmHg; P = 0.11). Ventricular septal defect occurred in 4 patients (0.3{\%}), and risk did not differ by group (P = 0.24). CONCLUSIONS: Adequate relief of left ventricular outflow tract obstruction can be achieved via transaortic septal myectomy without concomitant MV procedures when septal thickness is < 18 mm, and the risk of ventricular septal defect is minimal. Concomitant MV repair/replacement should be reserved for patients with intrinsic MV disease or inadequate relief of mitral regurgitation/left ventricular outflow tract obstruction following adequate extended septal myectomy.",
keywords = "Hypertrophic cardiomyopathy, Mitral valve, Myectomy, Septal thickness",
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T1 - Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy?

AU - Nguyen, Anita

AU - Schaff, Hartzell V

AU - Nishimura, Rick A.

AU - Dearani, Joseph A.

AU - Geske, Jeffrey B.

AU - Lahr, Brian D.

AU - Ommen, Steve R.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - OBJECTIVES: Patients with hypertrophic obstructive cardiomyopathy and basal septal thickness <18mm are often considered unsuitable candidates for myectomy. Mitral valve (MV) replacement is frequently performed instead. We aimed to determine whether septal thickness affects outcomes and adequacy of myectomy. METHODS: Clinical and echocardiographic data were reviewed for 1486 consecutive adult patients with hypertrophic obstructive cardiomyopathy who underwent transaortic septal myectomy from January 2005 through December 2014. Comparisons between patients, grouped by septal thickness (<18 mm, n = 369; 18-21 mm, n = 612 and >21 mm, n = 505), were performed with the Kruskal-Wallis and the Pearson χ2 tests and semiparametric analysis of covariance. RESULTS: Median group ages were 57, 57 and 54 years (P = 0.007); men comprised 50.4%, 56.7% and 62.0%, respectively (P = 0.003). Intrinsic MV disease was present in 5.9%, 5.2% and 4.6%, respectively (P = 0.80). All patients underwent transaortic septal myectomy. Additional mitral procedures were performed in 7.6%, 7.8% and 8.1%, respectively (P = 0.90). Reasons for MV surgery included intrinsic MV disease (66.7%), residual mitral regurgitation (30.8%) and residual gradient (2.6%). All groups had postoperative gradient relief (median reduction: 51, 54 and 50 mmHg; P = 0.11). Ventricular septal defect occurred in 4 patients (0.3%), and risk did not differ by group (P = 0.24). CONCLUSIONS: Adequate relief of left ventricular outflow tract obstruction can be achieved via transaortic septal myectomy without concomitant MV procedures when septal thickness is < 18 mm, and the risk of ventricular septal defect is minimal. Concomitant MV repair/replacement should be reserved for patients with intrinsic MV disease or inadequate relief of mitral regurgitation/left ventricular outflow tract obstruction following adequate extended septal myectomy.

AB - OBJECTIVES: Patients with hypertrophic obstructive cardiomyopathy and basal septal thickness <18mm are often considered unsuitable candidates for myectomy. Mitral valve (MV) replacement is frequently performed instead. We aimed to determine whether septal thickness affects outcomes and adequacy of myectomy. METHODS: Clinical and echocardiographic data were reviewed for 1486 consecutive adult patients with hypertrophic obstructive cardiomyopathy who underwent transaortic septal myectomy from January 2005 through December 2014. Comparisons between patients, grouped by septal thickness (<18 mm, n = 369; 18-21 mm, n = 612 and >21 mm, n = 505), were performed with the Kruskal-Wallis and the Pearson χ2 tests and semiparametric analysis of covariance. RESULTS: Median group ages were 57, 57 and 54 years (P = 0.007); men comprised 50.4%, 56.7% and 62.0%, respectively (P = 0.003). Intrinsic MV disease was present in 5.9%, 5.2% and 4.6%, respectively (P = 0.80). All patients underwent transaortic septal myectomy. Additional mitral procedures were performed in 7.6%, 7.8% and 8.1%, respectively (P = 0.90). Reasons for MV surgery included intrinsic MV disease (66.7%), residual mitral regurgitation (30.8%) and residual gradient (2.6%). All groups had postoperative gradient relief (median reduction: 51, 54 and 50 mmHg; P = 0.11). Ventricular septal defect occurred in 4 patients (0.3%), and risk did not differ by group (P = 0.24). CONCLUSIONS: Adequate relief of left ventricular outflow tract obstruction can be achieved via transaortic septal myectomy without concomitant MV procedures when septal thickness is < 18 mm, and the risk of ventricular septal defect is minimal. Concomitant MV repair/replacement should be reserved for patients with intrinsic MV disease or inadequate relief of mitral regurgitation/left ventricular outflow tract obstruction following adequate extended septal myectomy.

KW - Hypertrophic cardiomyopathy

KW - Mitral valve

KW - Myectomy

KW - Septal thickness

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