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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 2000 Dicembre;41(6):801-6
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.