Document Detail


Extended myectomy for hypertrophic obstructive cardiomyopathy after failure or contraindication of septal ablation or with combined surgical procedures.
MedLine Citation:
PMID:  15573275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Surgical correction of hypertrophic obstructive cardiomyopathy in severely symptomatic patients has been proven to be effective over the long term. The introduction of catheter-based procedures restricts surgical therapy to a subset of patients not suitable for septal ablation or requiring concomitant cardiac surgery. METHODS: Between 8/2001 and 8/2003, 25 patients (58 +/- 15 years) underwent extended transaortic septal myectomy with partial excision and mobilization of the papillary muscles. Concomitant surgical procedures were performed in 40 % (CABG n = 9, aortic valve replacement n = 2). In 24 %, prior septal ablation was ineffective. Intraventricular gradient was 80 +/- 29 mm Hg at rest and 143 +/- 35 mm Hg during exercise. Mitral regurgitation affected 72 % of patients, and 88 % were NYHA functional class III or IV. RESULTS: No hospital death, no postsurgical ventricular septal defect, and no complete atrioventricular block occurred. Severe nonfatal complications occurred in 24 % of patients. Intensive care was necessary for 1.8 +/- 1.7 days; total hospital stay was 11.8 +/- 3.8 days. Early follow-up was complete in 100 % (15 +/- 6 months, total of 376 months) with no late deaths, no relevant mitral regurgitation, or intraventricular gradients. Functional status was markedly improved (NYHA class I 40 %, class II 56 %, class III 4 %). CONCLUSIONS: Early results of extended surgical myectomy and reconstruction of the subvalvular mitral apparatus in hypertrophic obstructive cardiomyopathy remain excellent with respect to mortality, morbidity, and functional capacity even when restricting surgery to patients earlier supposed to be at high risk.
Authors:
H Dörge; J D Schmitto; O J Liakopoulos; S Walther; F A Schöndube
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  52     ISSN:  0171-6425     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-01     Completed Date:  2006-07-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  344-8     Citation Subset:  IM    
Affiliation:
Thoracic Cardiovascular Surgery, Heart Center Göttingen, Georg-August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. doerge@med.uni-goettingen.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cardiomyopathy, Hypertrophic / surgery*,  therapy
Catheter Ablation*
Combined Modality Therapy
Coronary Artery Bypass
Female
Follow-Up Studies
Heart Septum / surgery*
Heart Valve Prosthesis Implantation
Heart Ventricles / surgery
Humans
Length of Stay
Male
Middle Aged
Mitral Valve Insufficiency / surgery
Reoperation
Severity of Illness Index
Surgical Procedures, Minimally Invasive
Time Factors
Treatment Failure
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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