Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

2021 ◽  
pp. 021849232110561
Author(s):  
Alexandr V. Afanasyev ◽  
Alexandr V. Bogachev-Prokophiev ◽  
Sergei I. Zheleznev ◽  
Anton S. Zalesov ◽  
Sergei A. Budagaev ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Pacemaker Implantation ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Alcohol Septal Ablation ◽  
Safety And Efficacy ◽  
Septal Myectomy ◽  
Early Results

Background We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. Results The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02–11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. Conclusions The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.

scholarly journals Рекомендации Американской ассоциации сердца / Американского колледжа кардиологии 2020 года по диагностике и лечению пациентов с гипертрофической кардиомиопатией: что нового?

2021 ◽  
Vol 25 (2) ◽  
pp. 108
Author(s):  
С. А. Будагаев ◽  
А. В. Афанасьев ◽  
А. В. Богачев-Прокофьев ◽  
А. С. Залесов ◽  
М. А. Овчаров
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Conflict Of Interest ◽  
Severe Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Alcohol Septal Ablation ◽  
Ventricular Ejection Fraction ◽  
Septal Myectomy ◽  
Obstructive Hypertrophic Cardiomyopathy

<p>On 22 December 2020, <em>Circulation</em> published the new American College of Cardiology / American Heart Association guidelines for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. The most important guidelines were those concerning pharmacological and invasive methods of treating symptomatic patients with obstruction of the left ventricular outlet. Considering the most recent clinical studies, the indications for invasive methods of treatment have expanded to include septal myectomy and alcohol septal ablation. A separate section in the guidelines has been devoted to the management of non-obstructive hypertrophic cardiomyopathy with preserved left ventricular ejection fraction. The recommendations for patients with hypertrophic cardiomyopathy with atrial fibrillation, ventricular arrhythmias and severe heart failure have been revised.</p><p>Received 26 March 2021. Revised 12 May 2021. Accepted 13 May 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev<br />Data collection and analysis: S.A. Budagaev, M.A. Ovcharov<br />Drafting the article: S.A. Budagaev, A.V. Afanasyev, A.S. Zalesov<br />Critical revision of the article: A.V. Bogachev-Prokophiev<br />Final approval of the version to be published: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev, A.S. Zalesov, <br />M.A. Ovcharov</p>

scholarly journals Application of mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: A single-center experience with 168 cases

2020 ◽  
Author(s):  
Qiang Ji ◽  
YuLin Wang ◽  
Ye Yang ◽  
Hao Lai ◽  
WenJun Ding ◽  
...  
Keyword(s):  
New York ◽  
Pacemaker Implantation ◽  
Heart Association ◽  
Technical Difficulty ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Surgical Instruments ◽  
Septal Myectomy ◽  
Refractory Symptoms ◽  
Early Results

Abstract Background: Septal myectomy has been a standard treatment option for patients with hypertrophic obstructive cardiomyopathy (HOCM) and drug refractory symptoms. However, there are only a few experienced myectomy centers in the world so far, mainly because of high technical difficulty of myectomy. From our clinical experience, the use of the mini-invasive surgical instruments during myectomy may be beneficial to reduce the technical difficulty. This study reports the preliminary experience regarding transaortic septal myectomy using mini-invasive surgical instruments for the treatment of patients with HOCM and drug refractory symptoms, and evaluates the early results following myectomy.Methods Between March 2016 and March 2019, consecutive HOCM patients were included in this analysis who underwent isolated transaortic septal myectomy using the mini-invasive surgical instruments. Intraoperative, in-hospital and follow-up results were analyzed.Results A total of 168 eligible patients (83 males, mean 56.8 ± 12.3 years) were included. Midventricular obstruction was recorded in 7 (4.2%) patients. All included patients underwent transaortic septal myectomy with a mean aortic cross-clamping time of 36.0 ± 8.1 minutes. Nine (5.4%) patients received repeat aortic cross-clamping during surgery. Surgical mortality was 0.6%. Five (3.0%) patients developed complete atrioventricular block and required permanent pacemaker implantation. The median follow-up time was 6 months. No follow-up deaths occurred with a significant improvement in New York Heart Association functional status. The maximum gradients decreased sharply from the preoperative value (11.6 ± 7.4 mmHg vs. 94.4 ± 2 2.6 mmHg, p<0.001). The median degree of mitral regurgitation fell to 1.0 (vs. 3.0 preoperatively, p<0.001) with a significant reduction in the proportion of moderate or more regurgitation (1.2% vs. 57.7%, p<0.001).Conclusions The use of the mini-invasive surgical instruments may be beneficial to reduce the technical difficulty of transaortic septal myectomy procedure. Transaortic septal myectomy using the mini-invasive surgical instruments may be associated with favorable results.

scholarly journals A new approach to the assessment of outcomes of alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

2015 ◽  
Vol 17 (2) ◽  
pp. 46
Author(s):  
A. G. Osiev ◽  
Ye. I. Kretov ◽  
V. P. Kurbatov ◽  
S. P. Mironenko ◽  
R. A. Naydenov ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Interventricular Septum ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Alcohol Septal Ablation ◽  
New Approach ◽  
Surgical Interventions ◽  
Septal Myectomy ◽  
Left Ventricular Output ◽  
Cardiac Disorders

Hypertrophic cardiomyopathy is a heterogeneous disease characterized by myocardial hypertrophy, without any other systemic or cardiac disorders and with predominant involvement of the interventricular septum. Approximately 25% of patients have a dynamic obstruction of the left ventricular output tract due its constriction and abnormal systolic anterior motion of the mitral valve. Therapeutic strategy for patients with hypertrophic obstructive cardiomyopathy, who remain symptomatic despite drug therapy, includes surgery (septal myectomy) and non-surgical interventions, such as alcohol septal ablation. In the present study the possibility of cardiac MRI with contrast enhancement in the evaluation of the results of endovascular treatment hypertrophic cardiomyopathy and evidence for the benefits of this method in 25 patients with an obstructive form of hypertrophic cardiomyopathy after alcohol septal ablation are discussed.

scholarly journals Regional left ventricular wall movement in hypertrophic cardiomyopathy.

Heart ◽  
1978 ◽  
Vol 40 (12) ◽  
pp. 1327-1333 ◽  
Author(s):  
D G Gibson ◽  
J E Sanderson ◽  
T A Traill ◽  
D J Brown ◽  
J F Goodwin
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Wall Movement
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