Surgical septal myectomy during infancy for obstructive hypertrophic cardiomyopathy yielded favorable long-term outcomes similar to older children, though 2 of 12 infants required redo myectomy.
Cohort (n=23)
No
Does surgical septal myectomy performed during infancy compared to older childhood result in favorable perioperative and long-term clinical outcomes in pediatric patients with obstructive hypertrophic cardiomyopathy?
Surgical septal myectomy can be safely performed in infants with severe obstructive hypertrophic cardiomyopathy, yielding favorable long-term outcomes similar to older children, albeit with a potential trend toward higher reoperation rates.
OBJECTIVES: Surgical septal myectomy is performed to relieve left ventricular outflow tract narrowing in severe drug-refractory obstructive hypertrophic cardiomyopathy. The objective of this study was to assess the perioperative and long-term clinical outcome of this procedure performed during infancy. METHODS: Clinical, transthoracic echocardiographic, electrocardiographic, 24-h Holter, cardiopulmonary exercise test and genetic data were extracted by medical record review. A subset of patients underwent additional prospective detailed clinical evaluation including cardiac magnetic resonance imaging with contrast. RESULTS: Surgery was performed in 23 paediatric patients between 1978 and 2015 at the German Heart Centre Munich. Twelve patients had undergone surgery during infancy (≤ 1 year) (Group A), 11 between 1 and 18 years of age (Group B). The underlying genetic diagnosis was Noonan syndrome spectrum and non-syndromic hypertrophic cardiomyopathy. As compared to Group B, patients in Group A showed more concomitant cardiac procedures and received more homologous transfusions. One perioperative death occurred in Group A, and none in Group B. Two patients in Group A but no patient in Group B required redo septal myectomy. The long-term clinical outcome was similar between the 2 groups. One patient in Group B required cardioverter-defibrillator/pacemaker implantation for higher degree atrioventricular block and none in Group A. There was no evidence of differences in myocardial fibrosis between groups on long-term follow-up magnetic resonance imaging. CONCLUSIONS: Surgical septal myectomy can be performed safely during infancy with favourable perioperative and long-term clinical outcome but with a trend towards a higher reoperation rate later in life.
Schleihauf et al. (Wed,) conducted a cohort in obstructive hypertrophic cardiomyopathy (n=23). Surgical septal myectomy during infancy (≤ 1 year) vs. Surgical septal myectomy between 1 and 18 years of age was evaluated on Perioperative and long-term clinical outcome. Surgical septal myectomy during infancy for obstructive hypertrophic cardiomyopathy yielded favorable long-term outcomes similar to older children, though 2 of 12 infants required redo myectomy.
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