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. 2020 Jun;23(6):342-348.
doi: 10.14744/AnatolJCardiol.2020.05043.

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

Xiangbin Meng  1 , Mingyu Liang  2 , Yongen Shi  1 , Weijie Zhang  1 , Sijie Zhou  1 , Chuanyu Gao  1
Affiliations

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

Xiangbin Meng et al. Anatol J Cardiol. 2020 Jun.

Abstract

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 57.57±13.71 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: 0.013-0.877, p<0.037], age (HR: 1.047; 95% CI: 1.007-1.088, p=0.021), and previous AF (HR: 2.659; 95% CI: 1.022-6.919, 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.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
The average LVOT gradient before and after surgical septum myectomy
Figure 2
Figure 2
Event-free survival
See this image and copyright information in PMC

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