The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years

R. Mohr, Hartzell V Schaff, G. K. Danielson, F. J. Puga, J. R. Pluth, A. J. Tajik, R. S. Mitchell, Q. R. Stiles

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

From 1972 through 1987, 115 patients between the ages of 1 and 83 years (mean, 44.5 years) underwent operation for hypertrophic obstructive cardiomyopathy. Methods of relief of left ventricular outflow obstruction were septal myectomy/myotomy (n = 109), mitral valve replacement (n = 4), and myectomy/myotomy plus mitral valve replacement (n = 2); concomitant procedures included coronary artery bypass (n = 19) and aortic valve replacement (n = 9). Systolic gradient (peak-to-peak) from the left ventricle to the aorta decreased from 70 ± 38mm Hg (mean ± standard deviation) to 9 ± 11 mm Hg. There were six hospitals deaths, for an overall operative risk of 5.2%; one death occurred among 83 patients less than age 65 years (operative risk, 1.2%), and five deaths occurred in 32 older patients (operative risk, 15.6%; p = 0.008 for difference between age groups). Four (22.2%) of 18 patients with a residual gradient greater than 15 mm Hg died, compared with two (2.1%) of 97 patients with a lower gradient (p = 0.003). Follow-up ranged from 0.5 to 16 years (mean, 5.1 years), and 5-year actuarial survival rate, including hospital deaths, was 84% ± 4%. The 5-year survival rate was decreased in patients who had operative procedures other than myectomy/myotomy (69% versus 91%, p < 0.005) and in patients aged 65 years or older (54% versus 93%, p < 0.005). No correlation was found between preoperative symptoms, functional class, left ventricle-aorta pressure gradient, or mitral valve insufficiency and operative or late mortality. Preoperative symptoms were relieved in 57 (76%) of 75 patients with dyspnea, 49 (83%) of 59 patients with angina, and 22 (96%) of 23 patients with syncope. This experience confirms the effectiveness of operation for relief of symptoms in patients with the obstructive form of hypertrophic cardiomyopathy. The current operative mortality rate is low, especially in patients less than 65 years of age (1.2%). Our experience suggests that incomplete relief of left ventricular outflow obstruction may increase the risk of early postoperative death.

Original languageEnglish (US)
Pages (from-to)666-674
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume97
Issue number5
StatePublished - 1989

Fingerprint

Hypertrophic Cardiomyopathy
Ventricular Outflow Obstruction
Mitral Valve
Heart Ventricles
Aorta
Survival Rate
Mortality
Operative Surgical Procedures
Syncope
Mitral Valve Insufficiency
Aortic Valve
Coronary Artery Bypass
Dyspnea
Age Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mohr, R., Schaff, H. V., Danielson, G. K., Puga, F. J., Pluth, J. R., Tajik, A. J., ... Stiles, Q. R. (1989). The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years. Journal of Thoracic and Cardiovascular Surgery, 97(5), 666-674.

The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years. / Mohr, R.; Schaff, Hartzell V; Danielson, G. K.; Puga, F. J.; Pluth, J. R.; Tajik, A. J.; Mitchell, R. S.; Stiles, Q. R.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 97, No. 5, 1989, p. 666-674.

Research output: Contribution to journalArticle

Mohr, R, Schaff, HV, Danielson, GK, Puga, FJ, Pluth, JR, Tajik, AJ, Mitchell, RS & Stiles, QR 1989, 'The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years', Journal of Thoracic and Cardiovascular Surgery, vol. 97, no. 5, pp. 666-674.
Mohr, R. ; Schaff, Hartzell V ; Danielson, G. K. ; Puga, F. J. ; Pluth, J. R. ; Tajik, A. J. ; Mitchell, R. S. ; Stiles, Q. R. / The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years. In: Journal of Thoracic and Cardiovascular Surgery. 1989 ; Vol. 97, No. 5. pp. 666-674.
@article{c9cbbb349b7a4d349cb908a2fc03d587,
title = "The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years",
abstract = "From 1972 through 1987, 115 patients between the ages of 1 and 83 years (mean, 44.5 years) underwent operation for hypertrophic obstructive cardiomyopathy. Methods of relief of left ventricular outflow obstruction were septal myectomy/myotomy (n = 109), mitral valve replacement (n = 4), and myectomy/myotomy plus mitral valve replacement (n = 2); concomitant procedures included coronary artery bypass (n = 19) and aortic valve replacement (n = 9). Systolic gradient (peak-to-peak) from the left ventricle to the aorta decreased from 70 ± 38mm Hg (mean ± standard deviation) to 9 ± 11 mm Hg. There were six hospitals deaths, for an overall operative risk of 5.2{\%}; one death occurred among 83 patients less than age 65 years (operative risk, 1.2{\%}), and five deaths occurred in 32 older patients (operative risk, 15.6{\%}; p = 0.008 for difference between age groups). Four (22.2{\%}) of 18 patients with a residual gradient greater than 15 mm Hg died, compared with two (2.1{\%}) of 97 patients with a lower gradient (p = 0.003). Follow-up ranged from 0.5 to 16 years (mean, 5.1 years), and 5-year actuarial survival rate, including hospital deaths, was 84{\%} ± 4{\%}. The 5-year survival rate was decreased in patients who had operative procedures other than myectomy/myotomy (69{\%} versus 91{\%}, p < 0.005) and in patients aged 65 years or older (54{\%} versus 93{\%}, p < 0.005). No correlation was found between preoperative symptoms, functional class, left ventricle-aorta pressure gradient, or mitral valve insufficiency and operative or late mortality. Preoperative symptoms were relieved in 57 (76{\%}) of 75 patients with dyspnea, 49 (83{\%}) of 59 patients with angina, and 22 (96{\%}) of 23 patients with syncope. This experience confirms the effectiveness of operation for relief of symptoms in patients with the obstructive form of hypertrophic cardiomyopathy. The current operative mortality rate is low, especially in patients less than 65 years of age (1.2{\%}). Our experience suggests that incomplete relief of left ventricular outflow obstruction may increase the risk of early postoperative death.",
author = "R. Mohr and Schaff, {Hartzell V} and Danielson, {G. K.} and Puga, {F. J.} and Pluth, {J. R.} and Tajik, {A. J.} and Mitchell, {R. S.} and Stiles, {Q. R.}",
year = "1989",
language = "English (US)",
volume = "97",
pages = "666--674",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years

AU - Mohr, R.

AU - Schaff, Hartzell V

AU - Danielson, G. K.

AU - Puga, F. J.

AU - Pluth, J. R.

AU - Tajik, A. J.

AU - Mitchell, R. S.

AU - Stiles, Q. R.

PY - 1989

Y1 - 1989

N2 - From 1972 through 1987, 115 patients between the ages of 1 and 83 years (mean, 44.5 years) underwent operation for hypertrophic obstructive cardiomyopathy. Methods of relief of left ventricular outflow obstruction were septal myectomy/myotomy (n = 109), mitral valve replacement (n = 4), and myectomy/myotomy plus mitral valve replacement (n = 2); concomitant procedures included coronary artery bypass (n = 19) and aortic valve replacement (n = 9). Systolic gradient (peak-to-peak) from the left ventricle to the aorta decreased from 70 ± 38mm Hg (mean ± standard deviation) to 9 ± 11 mm Hg. There were six hospitals deaths, for an overall operative risk of 5.2%; one death occurred among 83 patients less than age 65 years (operative risk, 1.2%), and five deaths occurred in 32 older patients (operative risk, 15.6%; p = 0.008 for difference between age groups). Four (22.2%) of 18 patients with a residual gradient greater than 15 mm Hg died, compared with two (2.1%) of 97 patients with a lower gradient (p = 0.003). Follow-up ranged from 0.5 to 16 years (mean, 5.1 years), and 5-year actuarial survival rate, including hospital deaths, was 84% ± 4%. The 5-year survival rate was decreased in patients who had operative procedures other than myectomy/myotomy (69% versus 91%, p < 0.005) and in patients aged 65 years or older (54% versus 93%, p < 0.005). No correlation was found between preoperative symptoms, functional class, left ventricle-aorta pressure gradient, or mitral valve insufficiency and operative or late mortality. Preoperative symptoms were relieved in 57 (76%) of 75 patients with dyspnea, 49 (83%) of 59 patients with angina, and 22 (96%) of 23 patients with syncope. This experience confirms the effectiveness of operation for relief of symptoms in patients with the obstructive form of hypertrophic cardiomyopathy. The current operative mortality rate is low, especially in patients less than 65 years of age (1.2%). Our experience suggests that incomplete relief of left ventricular outflow obstruction may increase the risk of early postoperative death.

AB - From 1972 through 1987, 115 patients between the ages of 1 and 83 years (mean, 44.5 years) underwent operation for hypertrophic obstructive cardiomyopathy. Methods of relief of left ventricular outflow obstruction were septal myectomy/myotomy (n = 109), mitral valve replacement (n = 4), and myectomy/myotomy plus mitral valve replacement (n = 2); concomitant procedures included coronary artery bypass (n = 19) and aortic valve replacement (n = 9). Systolic gradient (peak-to-peak) from the left ventricle to the aorta decreased from 70 ± 38mm Hg (mean ± standard deviation) to 9 ± 11 mm Hg. There were six hospitals deaths, for an overall operative risk of 5.2%; one death occurred among 83 patients less than age 65 years (operative risk, 1.2%), and five deaths occurred in 32 older patients (operative risk, 15.6%; p = 0.008 for difference between age groups). Four (22.2%) of 18 patients with a residual gradient greater than 15 mm Hg died, compared with two (2.1%) of 97 patients with a lower gradient (p = 0.003). Follow-up ranged from 0.5 to 16 years (mean, 5.1 years), and 5-year actuarial survival rate, including hospital deaths, was 84% ± 4%. The 5-year survival rate was decreased in patients who had operative procedures other than myectomy/myotomy (69% versus 91%, p < 0.005) and in patients aged 65 years or older (54% versus 93%, p < 0.005). No correlation was found between preoperative symptoms, functional class, left ventricle-aorta pressure gradient, or mitral valve insufficiency and operative or late mortality. Preoperative symptoms were relieved in 57 (76%) of 75 patients with dyspnea, 49 (83%) of 59 patients with angina, and 22 (96%) of 23 patients with syncope. This experience confirms the effectiveness of operation for relief of symptoms in patients with the obstructive form of hypertrophic cardiomyopathy. The current operative mortality rate is low, especially in patients less than 65 years of age (1.2%). Our experience suggests that incomplete relief of left ventricular outflow obstruction may increase the risk of early postoperative death.

UR - http://www.scopus.com/inward/record.url?scp=0024605465&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024605465&partnerID=8YFLogxK

M3 - Article

C2 - 2709859

AN - SCOPUS:0024605465

VL - 97

SP - 666

EP - 674

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 5

ER -