Septal Myectomy is Safe and Effective at a Medium Volume Center
Igor Gosev, Robert Neely, Marzia Leacche, Maroon Yammine, Siobhan Mcgurk, Joshua Levy, Suyog Mokashi, Carolin Y. Ho, Neil Lakdawala, Calum A. MacRae, Christine E. Seidman, Prem S. Shekar
Brigham and Women’s Hospital, Boston, MA
OBJECTIVE: Septal myectomy is the gold standard for the treatment of symptomatic hypertrophic cardiomyopathy (HCM) refractory to medical therapy. Outcomes from high volume centers have dominated the literature. We report results from a medium volume center.
METHODS: This retrospective review includes 47 patients who underwent septal myectomy for HCM between 1/2004 and 4/2014. Measured outcomes included new pacemaker placement, mortality, sustained reduction of left ventricular outflow tract (LVOT) gradient and New York Heart Association (NYHA) class.
RESULTS: The mean age was 57 ±12yrs, and 47% (22) were women. Preoperatively, mean peak LVOT gradient was 79mmHg ( ±30), 39% (18) of patients had moderate/severe mitral regurgitation and 47% (22) were in NYHA class III/IV. Concomitant procedures included mitral (17) and aortic (8) valves, CABG (6), and aortic procedures (3). Immediate postoperative mean peak LVOT gradient was 14mmHg ±7 (p<0.001 vs. baseline). Operative mortality was 2% (1) and 15% (7) had new pacemakers. Median time to follow-up was 22 months where the mean peak LVOT gradient was 14mmHg ±8 and 9% (4) patients were NYHA class III/IV (both p ‰¤0.001 vs. baseline). Among 15 patients ‰¥3yrs from surgery (median 5.2 yrs), mean peak LVOT gradient was 13mmHg ±8 (p ‰¤0.001 vs. baseline). There was one late death and one reoperative septal myectomy at 5yrs.
CONCLUSIONS: Our series shows low operative mortality, sustained peak LVOT gradient reductions and improved symptomatology. These outcomes are comparable to published data from high volume centers. Septal myectomy at our medium volume center is safe and effective for medically refractory HCM.