SURGICAL-MANAGEMENT OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY - EARLY AND LATE RESULTS

From 1975 through 1993, 178 patients underwent surgical management of hypertrophic obstructive cardiomyopathy. Operations included isolated septal myectomy (n = 95), septal myectomy and coronary artery bypass g rafting (n = 41), septal myectomy plus a valve procedure (n = 25), sep tal myectomy, valve procedure, and coronary artery bypass grafting (n = 14), and mitral valve replacement without septal myectomy (n = 3). R ecent myectomy results were monitored with transesophageal echocardiog raphy, After initial myectomy, 32 patients (20%) underwent a second pu mp run for more extensive myectomy only (n = 22), mitral valve replace ment only (n = 5), or both (n = 2). In-hospital mortality was 6% (n = 11) and 4% (n = 6) for patients undergoing septal myectomy or septal m yectomy plus coronary artery bypass grafting, respectively. Heart bloc k occurred in 17 patients (10%). Left ventricular outflow tract systol ic gradients decreased from a mean of 93 mm Hg to 21 mm Hg after myect omy. Late survival was 86% and 70% at 5 and 10 postoperative years, re spectively, and 93% and 79% for patients undergoing septal myectomy al one or septal myectomy plus coronary artery bypass grafting, respectiv ely. Only 3 of 131 in-hospital survivors of septal myectomy or septal myectomy plus coronary artery bypass grafting died late cardiac deaths , for a yearly mortality of 0.6%. However, the 5-year late survival of patients undergoing valve operation plus septal myectomy was 51%, and multivariate testing confirmed the adverse influence on late survival (p = 0.008), as well as adverse influences of increasing age (p = 0.0 16) and return to cardiopulmonary bypass for mitral valve replacement (p = 0.038). At follow-up 136 patients (94%) had New York Heart Associ ation class I or II symptoms. For patients with hypertrophic obstructi ve cardiomyopathy, septal myectomy alone or in combination with corona ry artery bypass grafting produces effective symptom relief, excellent long-term survival, and a low risk of late cardiac death.