S. Mokashi1, I. Gosev1, S. McGurk1, M. Yammine1, K. Rajab1, P. S. Shekar1 1Brigham And Women’s Hospital,Cardiac Surgery,Boston, MA, USA
Introduction: Septal myectomy is the standard treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) refractory to medical therapy. To date, only outcomes from high volume centers have been reported. Herein we report mid-term results from a medium volume center.
Methods: A retrospective review of 47 patients undergoing septal myectomy for HOCM over a 10-year period was performed. Primary and secondary endpoints included: mortality, pacemaker placement, peak left ventricular outflow tract (LVOT) gradient and New York Heart Association (NYHA) class.
Results:The mean age was 57yrs ±12, and 47% (22) were women. Mean LVOT gradient was 79mmHg (±30), 39% (18) of patients had moderate or severe mitral regurgitation and 47% (22) were in NYHA class III/IV at baseline. Concomitant procedures included mitral valves (17), CABG (6), and aortas (3). Immediate postoperative LVOT gradient was 14mmHg±7 (p<0.001 vs. baseline). Operative mortality was 2% (1), and 15% (7) patients had new pacemaker placements. Median time to follow-up was 22 months, the mean LVOT gradient was 14mmHg±8 and 9% (4) patients were in NYHA class III/IV (both p ≤0.001 vs. baseline). Among 15 patients who were ≥3yrs from surgery (median 5.2 yrs.), LVOT gradient was 13mmHg±8 (p≤0.001 vs. baseline). There was one late death during the observation period, and one reoperative septal myectomy at 5yrs.
Conclusion: Our series shows a low operative mortality, sustained peak LVOT gradient reductions and improved symptomatology. The outcomes herein are comparable to previously published data from high volume centers. Therefore, septal myectomy at a medium volume center is safe and effective for HOCM.
