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Effects of surgical septal myectomy on survival in patients with hypertrophic obstructive cardiomyopathy [Anatol J Cardiol]
Anatol J Cardiol. 2020; 23(6): 342-348 | DOI: 10.14744/AnatolJCardiol.2020.05043  

Effects of surgical septal myectomy on survival in patients with hypertrophic obstructive cardiomyopathy

Xiangbin Meng1, Mingyu Liang2, Yongen Shi1, Weijie Zhang1, Sijie Zhou1, Chuanyu Gao1
1Department of Cardiology, Zhengzhou University People's Hospital; Central China Fuwai Hospital; Central China Branch of the National Cardiovascular Center; Henan Provincial People's Hospital; Henan-China
2Xiangya School of Medicine, Central South University; Hunan-China

Objective: The purpose of this study was to determine the effects of surgical resection of muscle layer on the long-term survival of patients with hypertrophic obstructive cardiomyopathy (HOCM).
Methods: The original study cohort consisted of 552 patients with hypertrophic cardiomyopathy (HCM), including 380 patients with HOCM and 172 patients with nonobstructive HCM. All these patients had a definite diagnosis in our center from October 1, 2009, to December 31, 2012. They were divided into three groups, viz., HOCM with myectomy group (n=194), nonoperated HOCM group (n=186), and nonobstructive HCM group (n=172). Median follow-up duration was 57.5713.71 months, and the primary end point was a combination of mortality from all causes.
Results: In this survival study, we compared the prognoses of patients with HOCM after myectomy, patients with nonoperated HOCM, and patients with nonobstructive HCM. Among the three groups, the myectomy group showed a lower rate of reaching the all-cause mortality with statistically indistinguishable overall survival compared with patients with nonobstructive HCM (p=0.514). Among patients with left ventricular outflow tract (LVOT) obstruction, the overall survival in the myectomy group was noticeably better than that in the nonoperated HOCM group (log-rank p<0.001). Parameters that showed a significant univariate correlation with survival included age, previous atrial fibrillation (AF), NT-proBNP, Cr, myectomy, and LV ejection fraction. When these variables were entered in the multivariate model, the only independent predictors of survival were myotomy [hazard ratio (HR): 0.109; 95% CI: 0.0130.877, p<0.037], age (HR: 1.047; 95% CI: 1.0071.088, p=0.021), and previous AF (HR: 2.659; 95% CI: 1.0226.919, p=0.021).
Conclusion: Patients with HOCM undergoing myectomy appeared to suffer from a lower risk of reaching the all-cause mortality and demonstrated statistically indistinguishable overall survival compared with patients with nonobstructive HCM. Multivariate analysis clearly demonstrated myectomy as a powerful, independent factor of survival, confirming that the differences in long-term survival recorded in this study may be due to surgical improvement in the LVOT gradient.

Keywords: hypertrophic obstructive cardiomyopathy, myectomy, prognosis


Xiangbin Meng, Mingyu Liang, Yongen Shi, Weijie Zhang, Sijie Zhou, Chuanyu Gao. Effects of surgical septal myectomy on survival in patients with hypertrophic obstructive cardiomyopathy. Anatol J Cardiol. 2020; 23(6): 342-348

Corresponding Author: Chuanyu Gao, China


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