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The case for surgery in obstructive hypertrophic cardiomyopathy.

Abstract：

:Relief of left ventricular (LV) outflow obstruction in patients with hypertrophic cardiomyopathy (HCM) and disabling symptoms refractory to maximum medical management has historically been a surgical problem. Surgical septal myectomy permanently abolishes systolic anterior motion of the mitral valve and mitral regurgitation, while normalizing LV pressures and wall stress. Also, these salutary goals are achieved without encumbering patients with post-procedural devices (e.g., pacemakers or defibrillators) or creating potentially arrhythmogenic substrates, as may occur with alcohol septal ablation. Procedural morbidity and mortality risk with myectomy is similar to, and in some institutions less than those for alcohol septal ablation. Over four decades, reports from numerous centers worldwide have consistently and unequivocably documented the benefits of surgery on hemodynamic and functional state, restoring normal and acceptable quality of life to patients of all ages by largely reversing the complications of heart failure. Long-term survival after myectomy is similar to that of the general population and superior to non-operated patients with obstruction. The LV outflow tract morphology in HCM is heterogeneous and not uncommonly includes congenital anomalies of the mitral valve apparatus for which the surgeon has the flexibility to adapt the repair, often employing an extended myectomy. In the current atmosphere of increasing and perhaps excessive enthusiasm for newer catheter-based interventions, it is a critical time to promote and re-emphasize that surgery is the time-honored (and presently the most effective) treatment strategy for relieving heart failure-related disability resulting from dynamic LV outflow obstruction in HCM, and is the primary treatment option for this subgroup of severely symptomatic drug-refractory patients.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Maron BJ,Dearani JA,Ommen SR,Maron MS,Schaff HV,Gersh BJ,Nishimura RA

doi

10.1016/j.jacc.2004.04.063

subject

Has Abstract

pub_date

2004-11-16 00:00:00

pages

2044-53

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(04)01723-1

journal_volume

pub_type

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The case for surgery in obstructive hypertrophic cardiomyopathy.