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The Journal of Cardiovascular Surgery 2020 Sep 04

DOI: 10.23736/S0021-9509.20.11443-5


lingua: Inglese

Propensity score matched comparison of isolated, elective aortic valve replacement with and without concomitant septal myectomy: is it worth it?

Konstantin von ASPERN, Edoardo BIANCHI, Josephina HAUNSCHILD, Claudia DAHLENBURG, Martin MISFELD, Michael A. BORGER, Christian D. ETZ

University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany


BACKGROUND: Septal myectomy during open aortic valve replacement (AVR) is an effective surgical treatment for asymmetric secondary basal septal hypertrophy. Concerns regarding higher rates of complications associated with this procedure-such as permanent pacemaker implantation-have been raised. The aim of this study is to compare outcomes and complications of patients with and without concomitant septal myectomy using propensity score matching applied to a large, consecutive single center cohort.
METHODS: A total of 2199 consecutive patients undergoing either AVR with concomitant myectomy (AVR-M, N=212) or AVR alone (N=1987) were analyzed (2009-2015). Patients with previous cardiac or emergency surgery, concomitant cardiac procedures and endocarditis were excluded. As reference to previously published data, patient characteristics and outcomes of the overall cohort were examined and for comparison between groups propensity score matching utilized.
RESULTS: In the unmatched cohort, AVR-M patients were older (71.2±8 vs 67.6±10 years, p<0.001) and more often female (68% vs. 37%, p<0.001) in comparison to patients receiving only AVR. After matching (N=374) no significant difference in baseline features was evident. No significant difference in hospital mortality (2.1% vs. 1.6%, p=1.000) and pacemakerimplantation rate (5.3% vs. 3.7%, p=0.621) was observed. Mid-term survival was comparable between the two groups (86.1±5% vs. 84.4±5% after 6 years, p=0.957). The overall patient cohort showed a survival comparable to that of an adjusted regional normal population (p=0.178).
CONCLUSIONS: This study demonstrates that concomitant myectomy in patients undergoing AVR is a safe surgical technique resulting in comparable hospital mortality and mid-term survival. Concomitant septal myectomy seems not to be associated with an increased pacemaker implantation rate.

KEY WORDS: Aortic valve replacement; Septal myectomy; Septal basal hypertrophy; Morrow resection; Propensity matching

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