Surgical treatment for hypertrophic obstructive cardiomyopathy was associated with an 80% 10-year mortality rate versus 71% for medical therapy, despite more consistent symptom relief with surgery.
Cohort (n=112)
Absolute Event Rate: 80% vs 71%
Sixty-three patients operated upon for HOCM and 49 patients selected for non-surgical treatment have been followed-up for 15 years. Pre-operatively, surgical patients had a higher left ventricular outflow tract gradient at rest and, on the average, more severe symptoms than non-surgical patients. Septal myectomy relieved the pressure gradient and symptoms more consistently than long-term treatment with beta-blockers or verapamil. Within an average observation time of 7 1/2 years, there was late deterioration or death in almost half of the non-surgical patients but in less than one-quarter in the operated patients. The 10 year mortality rate was 80% in the surgical series and 71% in the non-surgical series. In operated patients, pre-operative symptomatic status was significantly related to early and late mortality. In medically treated patients, mortality was unrelated to symptoms; however, it was significantly lower in patients receiving long term treatment with beta-blockers or verapamil. In conclusion, a high basal pressure gradient associated to limiting symptoms is a clear-cut indication for surgery. Other indications are more debatable. In medically treated patients, long-term administration of beta-blockers or verapamil is beneficial even without symptoms as it appears to improve prognosis.
Röthlin et al. (Wed,) conducted a cohort in Hypertrophic obstructive cardiomyopathy (n=112). Surgical treatment (septal myectomy) vs. Medical treatment (beta-blockers or verapamil) was evaluated on 10-year mortality rate. Surgical treatment for hypertrophic obstructive cardiomyopathy was associated with an 80% 10-year mortality rate versus 71% for medical therapy, despite more consistent symptom relief with surgery.