Document Detail

Long-term follow-up in hypertrophic obstructive cardiomyopathy after septal myectomy.
MedLine Citation:
PMID:  9594839     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Controversy exists about the choice of treatment for patients with hypertrophic obstructive cardiomyopathy. The purpose of this study was to evaluate clinical and echocardiographic long-term results in patients with hypertrophic obstructive cardiomyopathy after septal myectomy and to determine predictors of event-free survival in these patients. METHODS: Between 1965 and 1995, 110 consecutive patients 2 to 66 years old (mean age, 37 +/- 15 years) with an invasively measured left ventricular outflow tract gradient of 86 +/- 39 mm Hg (81 +/- 42 mm Hg by Doppler echocardiography) underwent either septal myectomy only (n = 87) or myectomy combined with additional procedures (n = 23). Mean follow-up was 11.7 +/- 7.5 years. Predictors of late events were calculated using multivariate Cox regression analysis. RESULTS: The perioperative mortality rate was 3.6% (n = 4). The cumulative survival rate at 5, 10, and 15 years was 93%, 80%, and 72%, respectively, and symptom-free survival, 77%, 50%, and 33%, respectively. Predictors of late death were New York Heart Association class III or IV (p < 0.05), congestive heart failure (p < 0.05) and additional procedures (p < 0.05). The left ventricular outflow tract gradient was nearly eliminated in all patients, the left atrial dimension decreased significantly during the early years, and left ventricular dilatation occurred late in 17 patients. CONCLUSIONS: Septal myectomy is associated with a low perioperative mortality and a high late survival rate (72% at 15 years' follow-up). Septal myectomy is still an excellent modality in the treatment strategy for symptomatic patients with hypertrophic obstructive cardiomyopathy.
M H Schönbeck; H P Brunner-La Rocca; P R Vogt; M L Lachat; R Jenni; O M Hess; M I Turina
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  65     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-10     Completed Date:  1998-06-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1207-14     Citation Subset:  AIM; IM    
Department of Surgery, University Hospital, Zurich, Switzerland.
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MeSH Terms
Arrhythmias, Cardiac / etiology
Cardiomyopathy, Hypertrophic / pathology,  physiopathology,  surgery*,  ultrasonography
Child, Preschool
Dilatation, Pathologic / pathology
Disease-Free Survival
Echocardiography, Doppler
Evaluation Studies as Topic
Follow-Up Studies
Heart Atria / pathology
Heart Failure / physiopathology
Heart Septum / physiopathology,  surgery*,  ultrasonography
Heart Ventricles / pathology
Longitudinal Studies
Middle Aged
Multivariate Analysis
Postoperative Complications
Survival Rate
Ventricular Dysfunction, Left / physiopathology,  surgery,  ultrasonography

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