Clinical and Echocardiographic Determinants of Long-Term Survival After Surgical Myectomy in Obstructive Hypertrophic Cardiomyopathy
| Autor: | Richard Choi, Harry Rakowski, Anna Woo, Anthony Ralph-Edwards, William G. Williams, Samuel Siu, Katie Fedwick, E. Douglas Wigle, Evelyn Rozenblyum |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Heart disease Cardiomyopathy Electrocardiography Sex Factors Risk Factors Physiology (medical) Internal medicine Atrial Fibrillation medicine Humans Ventricular outflow tract Heart Atria Cardiac Surgical Procedures Survival analysis Aged Proportional hazards model business.industry Standard treatment Age Factors Atrial fibrillation Cardiomyopathy Hypertrophic Middle Aged Prognosis medicine.disease Survival Analysis Septal myectomy Surgery Treatment Outcome Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Circulation. 111:2033-2041 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.0000162460.36735.71 |
| Popis: | Background— Surgical myectomy has been the standard treatment for patients with drug-refractory obstructive hypertrophic cardiomyopathy. The clinical and echocardiographic predictors of long-term survival and freedom from cardiovascular morbidity after myectomy have been unclear. Methods and Results— We studied a consecutive cohort of 338 adult patients (age at operation 47±14 [range 18 to 77] years, 60% male) who underwent myectomy at our institution. Preoperative resting left ventricular outflow tract (LVOT) gradient was 66±32 mm Hg (range 5 to 158 mm Hg). Early postoperative mortality was 1.5% (5 deaths): 4 deaths occurred between 1978 and 1992, and 1 death occurred between 1993 and 2002. During long-term follow-up, 83% of patients reported an improvement to functional class I or II. The majority of patients (98%) had no resting LVOT gradient. Long-term survival was excellent, with 98±1% survival at 1 year, 95±1% at 5 years, and 83±3% at 10 years after myectomy. Multivariable Cox regression analysis identified 5 predictors of overall mortality: (1) age ≥50 years at surgery (hazard ratio [HR] 2.8, 95% CI 1.5 to 5.1, P =0.001), (2) female gender (HR 2.5, 95% CI 1.5 to 4.3, P =0.0009), (3) history of preoperative atrial fibrillation (HR 2.2, 95% CI 1.2 to 4.0, P =0.008), (4) concomitant CABG (HR 3.7, 95% CI 1.7 to 8.2, P =0.001), and (5) preoperative left atrial diameter ≥46 mm (HR 2.9, 95% CI 1.6 to 5.4, P =0.0008). Significant predictors of late major cardiovascular events found on multivariable analysis were (1) female gender (HR 3.3, 95% CI 2.0 to 5.4, P P =0.02), and (3) preoperative left atrial diameter ≥46 mm (HR 2.5, 95% CI 1.5 to 4.3, P =0.0008). Conclusions— Myectomy provides excellent relief for LVOT obstruction in patients with hypertrophic cardiomyopathy. Preoperative clinical and echocardiographic variables can predict long-term outcome after myectomy. |
| Databáze: | OpenAIRE |
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