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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2000 December;41(6):801-6

language: English

Long-term results after myectomy in 64 patients with hypertrophic obstructive cardiomyopathy (HOCM). Morphological and hemodynamic aspects

Minami K., Woltersdorf H., Kleikamp G., Böthig D., Koertke H., Koerfer R.

From the Department of Thoracic and Cardiovascular Surgery Heart Center NRW, Bad Oeynhausen University of Bochum, Germany


Background. The aim of ­this ­study was to ­observe the chang­es in ­left-ven­tric­u­lar mor­phol­o­gy, the improve­ment in hemo­dy­nam­ics and the sur­vi­val ­curves (accord­ing to Kaplan-Meier) of ­patients fol­low­ing trans­aor­tic myec­to­my.
Methods. From November 1985 to August 1997, trans­aor­tic myec­to­my accord­ing to Morrow’s pro­po­sal was car­ried out at the Heart Center NRW in Bad Oeynhausen in 64 ­patients ­with iso­lat­ed ­HOCM. At the ­time of oper­a­tion, the ­patient ­group includ­ed 33 wom­en and 31 men ­aged ­between 14 and 76 ­years (­mean 52.56 ­years). A hemo­dy­nam­i­cal­ly rele­vant aor­tic sten­o­sis was exclud­ed in all ­patients. Sixty-­three ­patients (98.4%) ­were eval­u­at­ed in ­total ­over a ­mean obser­va­tion peri­od of 4.6 ­years (4 ­months to 12 ­years). One ­patient ­lost ­touch ­with our hos­pi­tal.
Results. The clin­i­cal symp­toms accord­ing to ­NYHA ­grade ­could be ­improved post­op­er­a­tive­ly ­from 3.4±0.33 to 1.36±0.6 (p<0.001). The echoc­ar­di­o­graph­ic pre­op­er­a­tive pres­sure gra­di­ent ­between the ­left ven­tri­cle and the aor­ta was 73.2±14.8 mmHg at ­rest and 139.6±21.2 mmHg ­after prov­o­ca­tion by ven­tric­u­lar pre­ma­ture ­beats (VPBs). Postoperatively, the gra­di­ent was ­reduced sig­nif­i­cant­ly: 13.56±2.7 mmHg at ­rest and 23.3±10.7 mmHg ­after VPBs, respec­tive­ly (p<0.001). Perioperative com­pli­ca­tions ­occurred in 12 ­patients includ­ing 1 ear­ly ­death due to low-out­put syn­drome, cor­re­spond­ing to an ear­ly mor­tal­ity ­rate of 1.6%. Four ­patients ­died with­in a post­op­er­a­tive peri­od of 1 ­year to 9.5 ­years, ­none of ­them due to car­diac caus­es, 2 due to non-car­diac caus­es and 1 of ­unknown caus­es. In 2 ­patients a recur­rent ­HOCM ­occurred at 7 and 10 ­years ­after the myec­to­my and ­they ­were treat­ed by cath­e­ter inter­ven­tion ­with the alco­hol ­induced sep­tal infarc­tion.
Conclusions. Based on the 12-­year sur­vi­val ­rate of 76.64% in our ­study, trans­aor­tal myec­to­my accord­ing to Morrow rep­re­sents a ­safe and reli­able ­form of ther­a­py, ­with rel­a­tive­ly low per­i­op­er­a­tive mor­tal­ity and com­pli­ca­tion ­rates, ­also in the ­long-­term.

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