Treatment Modalities in Hypertrophic Obstructive Cardiomyopathy: Surgical Myectomy versus Percutaneous Septal Ablation
DOI:
https://doi.org/10.1532/HSF98.20071136Abstract
Background. The aim of this study was to compare the results of percutaneous septal myocardial ablation (PSMA) and surgical myectomy (SM) for decreasing the left ventricular outflow tract (LVOT) gradient, septal thickness, ventricular dimensions, and mitral regurgitation (MR) in patients with symptomatic hypertrophic obstructive cardiomyopathy.
Methods: We treated 40 patients (mean age, 24.4 ± 6.8 years; 34 male and 6 female patients) between June 2002 and April 2006. Twenty-four patients underwent SM, and 16 patients underwent PSMA. All patients were symptomatic despite maximal medical treatment and had an LVOT gradient higher than 65 mm Hg. Their echocardiographic data were recorded before and after the procedure and then compared. The patients were followed up postoperatively for a mean of 13 months.
Results: There was no mortality in either group. One year after the procedure, the LVOT gradients for the 2 groups were not statistically different. During the follow-up, moderate MR was found in 4 patients (25%) in the ablation group and in 2 patients (8.3%) in the myectomy group. Exercise capacity and New York Heart Association class improved after PSMA, whereas postoperative MR severity and effort capacity were better in the surgical group.
Conclusion: The 2 approaches yielded similar results with regard to reducing the LVOT gradient. We conclude that SM is preferable to PSMA in cases with MR.
References
Cooley DA. 1991. Surgical techniques for hypertrophic left ventricular obstructive myopathy including mitral valve plication. J Card Surg 6:29-33.nFerrari R, Rydén L. 2001. Hypertrophic cardiomyopathy: from molecular and genetic mechanisms to clinical management. Eur Heart J Suppl 3(Suppl L):L1-2.nGietzen FH, Leuner CJ, Raute-Kreinsen U, et al. 1999. Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH): catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 20:1342-54.nIvens E. 2004. Hypertrophic cardiomyopathy. Heart Lung Circ 13(Suppl 3):S48-55.nLakkis NM, Nagueh SF, Dunn JK, Killip D, Spencer WH 3rd. 2000. Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up. J Am Coll Cardiol 36:852-5.nLever HM. 2006. Selection of hypertrophic cardiomyopathy patients for myectomy or alcohol septal ablation. Anadolu Kardiyol Derg 6(Suppl 2):27-30.nMaron BJ. 2002. Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308-20.nMarwick TH, Stewart WJ, Lever HM, et al. 1992. Benefits of intraoperative echocardiography in the surgical management of hypertrophic cardiomyopathy. J Am Coll Cardiol 20:1066-72.nMcIntosh CI, Maron BJ, Cannon RO, Klues HG. 1992. Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Circulation 86(Suppl 2):60-7.nMorrow AG, Reitz BA, Epstein SE, et al. 1975. Operative treatment in hypertrophic subaortic stenosis: techniques, and the results of pre and postoperative assessments in 83 patients. Circulation 52:88-102.nRalph-Edwards A, Woo A, McCrindle BW, et al. 2005. Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score. J Thorac Cardiovasc Surg 129:351-8.nRoberts R, Sigwart U. 2005. Current concepts of the pathogenesis and treatment of hypertrophic cardiomyopathy. Circulation 112:293-6.nSchoendube FA, Klues HG, Reith S, Flachskampf FA, Hanrath P, Messmer BJ. 1995. Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation 92(9 Suppl):II122-7.nSeggewiss H, Faber L, Gleichmann U. 1999. Percutaneous transluminal septal ablation in hypertrophic obstructive cardiomyopathy. Thorac Cardiovasc Surg 47:94-100.nSigwart U. 2001. Non-surgical myocardial reduction for patients with hypertrophic obstructive cardiomyopathy. Eur Heart J Suppl 3(Suppl L):L38-42.nSitges M, Shiota T, Lever HM, et al. 2003. Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy. Am J Cardiol 91:817-21.nSpirito P, Seidman CE, McKenna WJ, Maron BJ. 1997. The management of hypertrophic cardiomyopathy. N Engl J Med 336:775-85.nTalreja DR, Nishimura RA, Edwards WD, et al. 2004. Alcohol septal ablation versus surgical septal myectomy: comparison of effects on atrioventricular conduction tissue. J Am Coll Cardiol 44:2329-32.nvan der Lee C, ten Cate FJ, Geleijnse ML, et al. 2005. Percutaneous versus surgical treatment for patients with hypertrophic obstructive cardiomyopathy and enlarged anterior mitral valve leaflets. Circulation 112:482-8.nWigle ED, Rakowski H, Kimball B, Wiliams WG. 1995. Hypertrophic cardiomyopathy: clinical spectrum and treatment. Circulation 92:1680-92.nWigle ED, Sasson Z, Henderson MA, et al. 1985. Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy: a review. Prog Cardiovasc Dis 28:1-83.nYacoub MH. 2005. Surgical versus alcohol septal ablation for hypertrophic obstructive cardiomyopathy: the pendulum swings. Circulation 112:450-2.nYoerger DM, Weyman AE. 2003. Hypertrophic obstructive cardiomyopathy: mechanism of obstruction and response to therapy. Rev Cardiovasc Med 4:199-215.nZhu YB, Rajan S, Kurian VM, Liu ZY. 2006. Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy. J Zhejiang Univ Sci B 7:148-53.n
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).