Long-term outcomes for different surgical strategies to treat left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Richard Collis, Oliver Watkinson, Constantinos O'Mahony, Oliver P. Guttmann, Antonis Pantazis, Maria Tome-Esteban, Victor Tsang, Venkatachalam Chandrasekaran, Christopher G.A. McGregor, Perry M. Elliott

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4 Scopus citations

Abstract

Aims: Surgical intervention is used to treat dynamic left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy. This study assesses the effect of different surgical strategies on long-term mortality and morbidity. Methods and results: In total, 347 patients underwent surgical intervention for LVOTO (1988–2015). Group A (n = 272) underwent septal myectomy; Group B (n = 33), septal myectomy and mitral valve (MV) repair; Group C (n = 22), myectomy and MV replacement; and Group D (n = 20), MV replacement alone. Median follow-up was 5.2 years (interquartile range 1.9–7.9). The mean resting LVOT gradient improved post-operatively from 71.9 ± 39.6 mmHg to 13.4 ± 18.5 mmHg (P < 0.05). Overall, 72.4% of patients improved by >1 New York Heart Association (NYHA) class; 58.9% of patients undergoing MV replacement alone did not improve their NYHA class. There were 5 perioperative deaths and 20 late deaths (>30 days). Survival rates at 1, 5 and 10 years respectively were 98.4, 96.9, 91.9% in Group A; 97.0, 92.4, 61.6% in Group B; 100.0, 100.0, 55.6% in Group C; and 94.7, 85.3, 85.3% in Group D (log-rank, P < 0.05). Long-term (>30 days) complications included atrial fibrillation (29.6%), transient ischaemic attack/stroke (2.4%) and heart failure hospitalisation (3.2%). There were 16 repeat surgical interventions at 3.0 years. Conclusion: Septal myectomy is a safe procedure resulting in symptomatic improvement in the majority of patients. The annual incidence of non-fatal disease-related complications after surgical treatment of LVOTO is relatively high. Patients who underwent MV replacements had poorer outcomes with less symptomatic benefit in spite of a similar reduction in LVOT gradients.

Original languageEnglish (US)
Pages (from-to)398-405
Number of pages8
JournalEuropean Journal of Heart Failure
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • Hypertrophic cardiomyopathy
  • Left ventricular outflow tract obstruction
  • Septal myectomy

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    Collis, R., Watkinson, O., O'Mahony, C., Guttmann, O. P., Pantazis, A., Tome-Esteban, M., Tsang, V., Chandrasekaran, V., McGregor, C. G. A., & Elliott, P. M. (2018). Long-term outcomes for different surgical strategies to treat left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. European Journal of Heart Failure, 20(2), 398-405. https://doi.org/10.1002/ejhf.1038