Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States.
- 2019
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: The primary surgical therapy for hypertrophic cardiomyopathy (HCM) with obstruction is septal myectomy (SM). The current outcomes of SM with and without concomitant mitral operations in the United States was examined using The Society of Thoracic Surgeons (STS) database. CONCLUSIONS: Septal myectomy for HCM is safe. SM alone may have risk-adjusted outcome advantages to SM+MVRR. SM and SM+MVr provide similar reduction in MR. Further longitudinal analyses are required to define technical efficacy and outcomes in selected pathoanatomic groups. Copyright (c) 2018. Published by Elsevier Inc. METHODS: From July 2014 through June 2017, 4,274 SM operations were performed. Emergent status, endocarditis, aortic stenosis, and planned aortic valve operations were excluded. In the final cohort of 2,382 patients, 1,581 (66.4%) received SM alone (Group 1), and 801 (33.6%) had SM with mitral valve repair or replacement (MVRR) (Group 2). Group 2 was subdivided into mitral valve repair (MVr, n=500) and replacement (MVR, n=301). Baseline characteristics were compared and risk-adjusted operative mortality and major morbidity were evaluated between treatment groups. RESULTS: Baseline comorbidity was lower in Group 1 vs. 2 and for MVr vs. MVR. Operative mortality and major morbidity was lower for Group 1 vs. 2 (1.6% vs. 2.8%, p=0.046; and 10.9% vs. 20.0%, p<0.001, respectively). For patients with severe 3-4+ mitral regurgitation (MR), SM alone was effective in reducing MR in 85.5% (355/415), and SM+MVr was effective in 88.0% (176/200), p=0.4061. Following risk adjustment, odds ratio for composite of mortality and major morbidity for Group 2 vs. Group 1 was 1.8 [95% CI 1.4-2.4] (p<0.0001).