Key result
Surgical myectomy for obstructive hypertrophic cardiomyopathy yielded 83% survival at 10 years, with age ≥50, female gender, preoperative AF, CABG, and LA diameter ≥46 mm predicting overall mortality.
Why the study?
What are the clinical and echocardiographic predictors of long-term survival and cardiovascular morbidity after surgical myectomy in patients with obstructive hypertrophic cardiomyopathy?
Cohort (n=338)
No
What are the clinical and echocardiographic predictors of long-term survival and cardiovascular morbidity after surgical myectomy in patients with obstructive hypertrophic cardiomyopathy?
Surgical myectomy provides excellent long-term survival and symptom relief in obstructive hypertrophic cardiomyopathy, with mortality predicted by older age, female gender, preoperative atrial fibrillation, concomitant CABG, and enlarged left atrium.
Answers are grounded in this paper and cite their sources.
Identifies mortality predictors after myectomy in obstructive HCM; extends observational data but should not yet change practice without prospective validation.
BACKGROUND: Surgical myectomy has been the standard treatment for patients with drug-refractory obstructive hypertrophic cardiomyopathy. The clinical and echocardiographic predictors of long-term survival and freedom from cardiovascular morbidity after myectomy have been unclear. METHODS AND RESULTS: We studied a consecutive cohort of 338 adult patients (age at operation 47+/-14 [range 18 to 77] years, 60% male) who underwent myectomy at our institution. Preoperative resting left ventricular outflow tract (LVOT) gradient was 66+/-32 mm Hg (range 5 to 158 mm Hg). Early postoperative mortality was 1.5% (5 deaths): 4 deaths occurred between 1978 and 1992, and 1 death occurred between 1993 and 2002. During long-term follow-up, 83% of patients reported an improvement to functional class I or II. The majority of patients (98%) had no resting LVOT gradient. Long-term survival was excellent, with 98+/-1% survival at 1 year, 95+/-1% at 5 years, and 83+/-3% at 10 years after myectomy. Multivariable Cox regression analysis identified 5 predictors of overall mortality: (1) age > or =50 years at surgery (hazard ratio [HR] 2.8, 95% CI 1.5 to 5.1, P=0.001), (2) female gender (HR 2.5, 95% CI 1.5 to 4.3, P=0.0009), (3) history of preoperative atrial fibrillation (HR 2.2, 95% CI 1.2 to 4.0, P=0.008), (4) concomitant CABG (HR 3.7, 95% CI 1.7 to 8.2, P=0.001), and (5) preoperative left atrial diameter > or =46 mm (HR 2.9, 95% CI 1.6 to 5.4, P=0.0008). Significant predictors of late major cardiovascular events found on multivariable analysis were (1) female gender (HR 3.3, 95% CI 2.0 to 5.4, P<0.0001), (2) history of preoperative atrial fibrillation (HR 1.9, 95% CI 1.1 to 3.3, P=0.02), and (3) preoperative left atrial diameter > or =46 mm (HR 2.5, 95% CI 1.5 to 4.3, P=0.0008). CONCLUSIONS: Myectomy provides excellent relief for LVOT obstruction in patients with hypertrophic cardiomyopathy. Preoperative clinical and echocardiographic variables can predict long-term outcome after myectomy.
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Woo et al. (2005) conducted a cohort in Obstructive Hypertrophic Cardiomyopathy (n=338). Surgical myectomy was evaluated on Overall mortality and late major cardiovascular events. Surgical myectomy for obstructive hypertrophic cardiomyopathy yielded 83% survival at 10 years, with age ≥50, female gender, preoperative AF, CABG, and LA diameter ≥46 mm predicting overall mortality.
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