Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center

This study evaluates operative approach and contemporary surgical outcomes in the management of left ventricular outflow tract obstruction by a single surgeon at a high-volume, specialized hypertrophic cardiomyopathy center. This is a retrospective review of 1559 consecutive operations for left vent...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2019-06, Vol.157 (6), p.2289-2299
Main Authors: Hodges, Kevin, Rivas, Carlos Godoy, Aguilera, José, Borden, Robert, Alashi, Alaa, Blackstone, Eugene H., Desai, Milind Y., Smedira, Nicholas G.
Format: Article
Language:English
Subjects:
Cardiac Surgical Procedures - methods
Cardiac Surgical Procedures - statistics & numerical data
Echocardiography
Female
Heart Septum - surgery
Heart Valve Prosthesis Implantation
Humans
hypertrophic obstructive cardiomyopathy
Male
Middle Aged
Mitral Valve - surgery
Mitral Valve Insufficiency - diagnostic imaging
Mitral Valve Insufficiency - surgery
mitral valve pathology
mitral valve repair
Retrospective Studies
septal myectomy
transesophageal echocardiography
Ventricular Outflow Obstruction - diagnostic imaging
Ventricular Outflow Obstruction - surgery
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Summary:This study evaluates operative approach and contemporary surgical outcomes in the management of left ventricular outflow tract obstruction by a single surgeon at a high-volume, specialized hypertrophic cardiomyopathy center. This is a retrospective review of 1559 consecutive operations for left ventricular outflow tract obstruction from 2005 to 2015. Demographic profiles, echocardiogram-derived ventricular morphology and hemodynamics, operative data, and in-hospital outcomes were analyzed. Of the 1559 operations, 586 were isolated septal myectomies, 522 were myectomies with mitral valve or subvalvular apparatus intervention, 422 were myectomies with another concomitant procedure, and 29 were isolated mitral valve interventions without myectomy. Common mitral valve interventions included anterior leaflet shortening (16%), chordae tendineae resection (9.8%), papillary muscle resection (7.2%), and papillary muscle reorientation (7.5%). Ninety-two patients underwent mitral valve replacement, 42 for left ventricular outflow tract obstruction and 50 for intrinsic mitral valve pathology. Patients undergoing mitral interventions had thinner septums (18 ± 0.4 mm vs 22 ± 0.5 mm, P 
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2018.11.148