Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy

Dominic J. Parry, Robert E. Raskin, Jeffery A. Poynter, Igo B. Ribero, Pietro Bajona, Harry Rakowski, Anna Woo, Anthony Ralph-Edwards

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Abstract

Background We report one surgeon's experience of corrective surgery for hypertrophic obstructive cardiomyopathy (HOCM) over a 10-year span and comment on factors that influence longer term outcomes. Septal myectomy (SM) and adjunctive procedures, including shortening of the aorta, a novel technique in HOCM patients, are described. Methods Perioperative data were obtained by retrospective review of institutional surgical databases between 2001 and 2011. Review of most recent echocardiogram and clinical status by telephone interview was performed. Results A total of 211 patients underwent SM for HOCM. There was a bimodal age distribution related to sex; mean age for males and females was 46 ± 13 and 54 ± 14 years, respectively (p < 0.001). Functional New York Heart Association (NYHA) class improved significantly after surgery; 79% were in class III-IV preoperatively and 84% were in class I-II at follow-up (p < 0.001). Sixty percent had angina of Canadian Cardiovascular Society (CCS) grade III-IV preoperatively and 89% were in CCS I-II at follow-up (p < 0.001). There were significant improvements in resting left ventricular outflow tract gradient (64 ± 36 to 5 ± 5 mm Hg, p < 0.001), right ventricular systolic pressure (36 ± 7.3 to 32 ± 8 mm Hg, p < 0.001), left atrial size (4.6 ± 0.7 to 4.3 ± 0.6 cm, p < 0.001), and grade of mitral regurgitation (moderate to severe mitral regurgitation 28% to 3.5%, p < 0.001). In-hospital mortality was 0.5%, 1 year survival 98.6%, and 5-year survival 98.1%. Predictors of worse clinical outcomes were preoperative NYHA and CCS class III-IV (p < 0.001, p = 0.05), new onset atrial fibrillation (p < 0.001), and female sex (p = 0.03). Conclusions Septal myectomy in patients with obstructive HOCM offers excellent symptom relief and minimal operative risk.

Original languageEnglish (US)
Pages (from-to)1213-1219
Number of pages7
JournalAnnals of Thoracic Surgery
Volume99
Issue number4
DOIs
StatePublished - Apr 1 2015

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Hypertrophic Cardiomyopathy
Mitral Valve Insufficiency
Survival
Age Distribution
Ventricular Pressure
Hospital Mortality
Atrial Fibrillation
Aorta
Databases
Interviews
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Parry, D. J., Raskin, R. E., Poynter, J. A., Ribero, I. B., Bajona, P., Rakowski, H., ... Ralph-Edwards, A. (2015). Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy. Annals of Thoracic Surgery, 99(4), 1213-1219. https://doi.org/10.1016/j.athoracsur.2014.11.020

Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy. / Parry, Dominic J.; Raskin, Robert E.; Poynter, Jeffery A.; Ribero, Igo B.; Bajona, Pietro; Rakowski, Harry; Woo, Anna; Ralph-Edwards, Anthony.

In: Annals of Thoracic Surgery, Vol. 99, No. 4, 01.04.2015, p. 1213-1219.

Research output: Contribution to journalArticle

Parry, DJ, Raskin, RE, Poynter, JA, Ribero, IB, Bajona, P, Rakowski, H, Woo, A & Ralph-Edwards, A 2015, 'Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy', Annals of Thoracic Surgery, vol. 99, no. 4, pp. 1213-1219. https://doi.org/10.1016/j.athoracsur.2014.11.020
Parry, Dominic J. ; Raskin, Robert E. ; Poynter, Jeffery A. ; Ribero, Igo B. ; Bajona, Pietro ; Rakowski, Harry ; Woo, Anna ; Ralph-Edwards, Anthony. / Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 4. pp. 1213-1219.
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abstract = "Background We report one surgeon's experience of corrective surgery for hypertrophic obstructive cardiomyopathy (HOCM) over a 10-year span and comment on factors that influence longer term outcomes. Septal myectomy (SM) and adjunctive procedures, including shortening of the aorta, a novel technique in HOCM patients, are described. Methods Perioperative data were obtained by retrospective review of institutional surgical databases between 2001 and 2011. Review of most recent echocardiogram and clinical status by telephone interview was performed. Results A total of 211 patients underwent SM for HOCM. There was a bimodal age distribution related to sex; mean age for males and females was 46 ± 13 and 54 ± 14 years, respectively (p < 0.001). Functional New York Heart Association (NYHA) class improved significantly after surgery; 79{\%} were in class III-IV preoperatively and 84{\%} were in class I-II at follow-up (p < 0.001). Sixty percent had angina of Canadian Cardiovascular Society (CCS) grade III-IV preoperatively and 89{\%} were in CCS I-II at follow-up (p < 0.001). There were significant improvements in resting left ventricular outflow tract gradient (64 ± 36 to 5 ± 5 mm Hg, p < 0.001), right ventricular systolic pressure (36 ± 7.3 to 32 ± 8 mm Hg, p < 0.001), left atrial size (4.6 ± 0.7 to 4.3 ± 0.6 cm, p < 0.001), and grade of mitral regurgitation (moderate to severe mitral regurgitation 28{\%} to 3.5{\%}, p < 0.001). In-hospital mortality was 0.5{\%}, 1 year survival 98.6{\%}, and 5-year survival 98.1{\%}. Predictors of worse clinical outcomes were preoperative NYHA and CCS class III-IV (p < 0.001, p = 0.05), new onset atrial fibrillation (p < 0.001), and female sex (p = 0.03). Conclusions Septal myectomy in patients with obstructive HOCM offers excellent symptom relief and minimal operative risk.",
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T1 - Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy

AU - Parry, Dominic J.

AU - Raskin, Robert E.

AU - Poynter, Jeffery A.

AU - Ribero, Igo B.

AU - Bajona, Pietro

AU - Rakowski, Harry

AU - Woo, Anna

AU - Ralph-Edwards, Anthony

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N2 - Background We report one surgeon's experience of corrective surgery for hypertrophic obstructive cardiomyopathy (HOCM) over a 10-year span and comment on factors that influence longer term outcomes. Septal myectomy (SM) and adjunctive procedures, including shortening of the aorta, a novel technique in HOCM patients, are described. Methods Perioperative data were obtained by retrospective review of institutional surgical databases between 2001 and 2011. Review of most recent echocardiogram and clinical status by telephone interview was performed. Results A total of 211 patients underwent SM for HOCM. There was a bimodal age distribution related to sex; mean age for males and females was 46 ± 13 and 54 ± 14 years, respectively (p < 0.001). Functional New York Heart Association (NYHA) class improved significantly after surgery; 79% were in class III-IV preoperatively and 84% were in class I-II at follow-up (p < 0.001). Sixty percent had angina of Canadian Cardiovascular Society (CCS) grade III-IV preoperatively and 89% were in CCS I-II at follow-up (p < 0.001). There were significant improvements in resting left ventricular outflow tract gradient (64 ± 36 to 5 ± 5 mm Hg, p < 0.001), right ventricular systolic pressure (36 ± 7.3 to 32 ± 8 mm Hg, p < 0.001), left atrial size (4.6 ± 0.7 to 4.3 ± 0.6 cm, p < 0.001), and grade of mitral regurgitation (moderate to severe mitral regurgitation 28% to 3.5%, p < 0.001). In-hospital mortality was 0.5%, 1 year survival 98.6%, and 5-year survival 98.1%. Predictors of worse clinical outcomes were preoperative NYHA and CCS class III-IV (p < 0.001, p = 0.05), new onset atrial fibrillation (p < 0.001), and female sex (p = 0.03). Conclusions Septal myectomy in patients with obstructive HOCM offers excellent symptom relief and minimal operative risk.

AB - Background We report one surgeon's experience of corrective surgery for hypertrophic obstructive cardiomyopathy (HOCM) over a 10-year span and comment on factors that influence longer term outcomes. Septal myectomy (SM) and adjunctive procedures, including shortening of the aorta, a novel technique in HOCM patients, are described. Methods Perioperative data were obtained by retrospective review of institutional surgical databases between 2001 and 2011. Review of most recent echocardiogram and clinical status by telephone interview was performed. Results A total of 211 patients underwent SM for HOCM. There was a bimodal age distribution related to sex; mean age for males and females was 46 ± 13 and 54 ± 14 years, respectively (p < 0.001). Functional New York Heart Association (NYHA) class improved significantly after surgery; 79% were in class III-IV preoperatively and 84% were in class I-II at follow-up (p < 0.001). Sixty percent had angina of Canadian Cardiovascular Society (CCS) grade III-IV preoperatively and 89% were in CCS I-II at follow-up (p < 0.001). There were significant improvements in resting left ventricular outflow tract gradient (64 ± 36 to 5 ± 5 mm Hg, p < 0.001), right ventricular systolic pressure (36 ± 7.3 to 32 ± 8 mm Hg, p < 0.001), left atrial size (4.6 ± 0.7 to 4.3 ± 0.6 cm, p < 0.001), and grade of mitral regurgitation (moderate to severe mitral regurgitation 28% to 3.5%, p < 0.001). In-hospital mortality was 0.5%, 1 year survival 98.6%, and 5-year survival 98.1%. Predictors of worse clinical outcomes were preoperative NYHA and CCS class III-IV (p < 0.001, p = 0.05), new onset atrial fibrillation (p < 0.001), and female sex (p = 0.03). Conclusions Septal myectomy in patients with obstructive HOCM offers excellent symptom relief and minimal operative risk.

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