Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy

Meghana R. Kunkala, Hartzell V Schaff, Rick A. Nishimura, Martin D. Abel, Paul Sorajja, Joseph A. Dearani, Steve R. Ommen

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Midventricular obstruction in hypertrophic cardiomyopathy (HCM) is less common than subaortic obstruction, and there are few data on outcomes after surgical treatment. Methods: We reviewed 56 consecutive patients (28 men) with HCM and midventricular obstruction who underwent myectomy between February 1997 and June 2012. Five patients had prior myectomy for subaortic obstruction. Mean age was 42 ± 17 years. Preoperatively, 51% of patients had dyspnea, and the remaining had palpitations (25%), angina (5%), or syncope (9%). Results: Midventricular obstruction was relieved by means of a transaortic myectomy in 5 patients, a transapical approach in 32 patients, and combined transaortic and transapical incisions in 19 patients. In 13 patients, an apical aneurysm or pouch was repaired at the time of midventricular myectomy. There were no early deaths. Intraoperative intraventricular gradients were reduced from 64 ± 32 mm Hg before myectomy to 6 ± 12 mm Hg postoperatively (p ≤ 0.0001). Early complications included atrial arrhythmias in 5 patients and reoperation for bleeding in 4 patients. Fifty patients had follow-up beyond 30 days (median, 1.6 years; range, 33 days to 13 years). Survival at 1 and 5 years was 100% and 95%, and average New York Heart Association class improved from 2.9 ± 0.7 preoperatively to 1.3 ± 0.6 postoperatively (p = 0.0001). There were no aneurysms related to the apical incision; 2 patients had late reoperation, 1 for resection of right atrial mass to prevent embolus. Conclusions: A transapical approach allows excellent exposure for midventricular myectomy and relief of intraventricular gradients and related symptoms. There were no complications unique to the apical incision, and 5-year survival was similar to expected survival (95% versus 97%).

Original languageEnglish (US)
Pages (from-to)564-570
Number of pages7
JournalAnnals of Thoracic Surgery
Volume96
Issue number2
DOIs
StatePublished - Aug 2013

Fingerprint

Hypertrophic Cardiomyopathy
Reoperation
Aneurysm
Survival
Syncope
Embolism
Dyspnea
Cardiac Arrhythmias
Hemorrhage

ASJC Scopus subject areas

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

Cite this

Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy. / Kunkala, Meghana R.; Schaff, Hartzell V; Nishimura, Rick A.; Abel, Martin D.; Sorajja, Paul; Dearani, Joseph A.; Ommen, Steve R.

In: Annals of Thoracic Surgery, Vol. 96, No. 2, 08.2013, p. 564-570.

Research output: Contribution to journalArticle

Kunkala, Meghana R. ; Schaff, Hartzell V ; Nishimura, Rick A. ; Abel, Martin D. ; Sorajja, Paul ; Dearani, Joseph A. ; Ommen, Steve R. / Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy. In: Annals of Thoracic Surgery. 2013 ; Vol. 96, No. 2. pp. 564-570.
@article{1889da77dae946ec9e0dfc3aa987577e,
title = "Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy",
abstract = "Background: Midventricular obstruction in hypertrophic cardiomyopathy (HCM) is less common than subaortic obstruction, and there are few data on outcomes after surgical treatment. Methods: We reviewed 56 consecutive patients (28 men) with HCM and midventricular obstruction who underwent myectomy between February 1997 and June 2012. Five patients had prior myectomy for subaortic obstruction. Mean age was 42 ± 17 years. Preoperatively, 51{\%} of patients had dyspnea, and the remaining had palpitations (25{\%}), angina (5{\%}), or syncope (9{\%}). Results: Midventricular obstruction was relieved by means of a transaortic myectomy in 5 patients, a transapical approach in 32 patients, and combined transaortic and transapical incisions in 19 patients. In 13 patients, an apical aneurysm or pouch was repaired at the time of midventricular myectomy. There were no early deaths. Intraoperative intraventricular gradients were reduced from 64 ± 32 mm Hg before myectomy to 6 ± 12 mm Hg postoperatively (p ≤ 0.0001). Early complications included atrial arrhythmias in 5 patients and reoperation for bleeding in 4 patients. Fifty patients had follow-up beyond 30 days (median, 1.6 years; range, 33 days to 13 years). Survival at 1 and 5 years was 100{\%} and 95{\%}, and average New York Heart Association class improved from 2.9 ± 0.7 preoperatively to 1.3 ± 0.6 postoperatively (p = 0.0001). There were no aneurysms related to the apical incision; 2 patients had late reoperation, 1 for resection of right atrial mass to prevent embolus. Conclusions: A transapical approach allows excellent exposure for midventricular myectomy and relief of intraventricular gradients and related symptoms. There were no complications unique to the apical incision, and 5-year survival was similar to expected survival (95{\%} versus 97{\%}).",
author = "Kunkala, {Meghana R.} and Schaff, {Hartzell V} and Nishimura, {Rick A.} and Abel, {Martin D.} and Paul Sorajja and Dearani, {Joseph A.} and Ommen, {Steve R.}",
year = "2013",
month = "8",
doi = "10.1016/j.athoracsur.2013.04.073",
language = "English (US)",
volume = "96",
pages = "564--570",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy

AU - Kunkala, Meghana R.

AU - Schaff, Hartzell V

AU - Nishimura, Rick A.

AU - Abel, Martin D.

AU - Sorajja, Paul

AU - Dearani, Joseph A.

AU - Ommen, Steve R.

PY - 2013/8

Y1 - 2013/8

N2 - Background: Midventricular obstruction in hypertrophic cardiomyopathy (HCM) is less common than subaortic obstruction, and there are few data on outcomes after surgical treatment. Methods: We reviewed 56 consecutive patients (28 men) with HCM and midventricular obstruction who underwent myectomy between February 1997 and June 2012. Five patients had prior myectomy for subaortic obstruction. Mean age was 42 ± 17 years. Preoperatively, 51% of patients had dyspnea, and the remaining had palpitations (25%), angina (5%), or syncope (9%). Results: Midventricular obstruction was relieved by means of a transaortic myectomy in 5 patients, a transapical approach in 32 patients, and combined transaortic and transapical incisions in 19 patients. In 13 patients, an apical aneurysm or pouch was repaired at the time of midventricular myectomy. There were no early deaths. Intraoperative intraventricular gradients were reduced from 64 ± 32 mm Hg before myectomy to 6 ± 12 mm Hg postoperatively (p ≤ 0.0001). Early complications included atrial arrhythmias in 5 patients and reoperation for bleeding in 4 patients. Fifty patients had follow-up beyond 30 days (median, 1.6 years; range, 33 days to 13 years). Survival at 1 and 5 years was 100% and 95%, and average New York Heart Association class improved from 2.9 ± 0.7 preoperatively to 1.3 ± 0.6 postoperatively (p = 0.0001). There were no aneurysms related to the apical incision; 2 patients had late reoperation, 1 for resection of right atrial mass to prevent embolus. Conclusions: A transapical approach allows excellent exposure for midventricular myectomy and relief of intraventricular gradients and related symptoms. There were no complications unique to the apical incision, and 5-year survival was similar to expected survival (95% versus 97%).

AB - Background: Midventricular obstruction in hypertrophic cardiomyopathy (HCM) is less common than subaortic obstruction, and there are few data on outcomes after surgical treatment. Methods: We reviewed 56 consecutive patients (28 men) with HCM and midventricular obstruction who underwent myectomy between February 1997 and June 2012. Five patients had prior myectomy for subaortic obstruction. Mean age was 42 ± 17 years. Preoperatively, 51% of patients had dyspnea, and the remaining had palpitations (25%), angina (5%), or syncope (9%). Results: Midventricular obstruction was relieved by means of a transaortic myectomy in 5 patients, a transapical approach in 32 patients, and combined transaortic and transapical incisions in 19 patients. In 13 patients, an apical aneurysm or pouch was repaired at the time of midventricular myectomy. There were no early deaths. Intraoperative intraventricular gradients were reduced from 64 ± 32 mm Hg before myectomy to 6 ± 12 mm Hg postoperatively (p ≤ 0.0001). Early complications included atrial arrhythmias in 5 patients and reoperation for bleeding in 4 patients. Fifty patients had follow-up beyond 30 days (median, 1.6 years; range, 33 days to 13 years). Survival at 1 and 5 years was 100% and 95%, and average New York Heart Association class improved from 2.9 ± 0.7 preoperatively to 1.3 ± 0.6 postoperatively (p = 0.0001). There were no aneurysms related to the apical incision; 2 patients had late reoperation, 1 for resection of right atrial mass to prevent embolus. Conclusions: A transapical approach allows excellent exposure for midventricular myectomy and relief of intraventricular gradients and related symptoms. There were no complications unique to the apical incision, and 5-year survival was similar to expected survival (95% versus 97%).

UR - http://www.scopus.com/inward/record.url?scp=84881186730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881186730&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2013.04.073

DO - 10.1016/j.athoracsur.2013.04.073

M3 - Article

C2 - 23809730

AN - SCOPUS:84881186730

VL - 96

SP - 564

EP - 570

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -