Extended Septal Myectomy in Obstructive Hypertrophic Cardiomyopathy. Clinical Results and Mid-term Echocardiographic Outcome

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Abstract

Background: Extended septal myectomy is the treatment of choice for patients with symptomatic obstructive hypertrophic cardiomyopathy, refractory to pharmacological treatment.
Objectives: The aim of this study was to evaluate postoperative results, symptom changes and echocardiographic outcome in a population undergoing extended septal myectomy for symptomatic obstructive hypertrophic cardiomyopathy.
Methods: A total of 28 patients were operated on from November 2011 to October 2017. Postoperative, clinical and echocardiographic outcomes were analyzed at discharge and during follow-up.
Results: Mean age was 53.3±13.4 years. Perioperative mortality (<30 days) was 0%. One patient died 90 days after the procedure
(3.5%). No septal defect, aortic valve injury or mitral valve replacement occurred in any patient. Ninety-one percent of patients were in FC III-IV, and the rest had angina or syncope. During follow-up, 92.8% were asymptomatic; one patient was in FC III and another in FC II. Preoperative basal average gradient was 53.5 mmHg and with Valsalva maneuver 86.4 mmHg, and postoperative
basal and with Valsalva gradient was 9.4 mmHg and 13.5 mmHg, respectively (p <0.01). During follow-up, gradients at rest and with Valsalva were even lower: 8.3 mmHg and 10.7 mmHg, respectively (p: NS). Nine patients (32%) presented prior moderate to severe mitral regurgitation due to mitral valve systolic anterior motion or intrinsic disease. Only one patient had evidence of asymptomatic moderate mitral regurgitation at follow-up (3.5%). Median follow-up was 400 days (25-75 IQR: 695 days; minimum: 30 days and
maximum: 1,868 days).
Conclusion: Extended septal myectomy improves hemodynamic and clinical outcome in symptomatic patients, with a low number of
postoperative complications, resulting in better quality of life.