PMID- 20103321
OWN - NLM
STAT- MEDLINE
DCOM- 20100217
LR  - 20100127
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 89
IP  - 2
DP  - 2010 Feb
TI  - Concomitant septal myectomy at the time of aortic valve replacement for severe 
      aortic stenosis.
PG  - 459-64
LID - 10.1016/j.athoracsur.2009.10.065 [doi]
AB  - BACKGROUND: Left ventricular outflow tract obstruction may be unmasked after a 
      successful aortic valve replacement (AVR) for severe aortic stenosis in the 
      setting of asymmetrical basal septal hypertrophy (ABSH). The quantitative 
      assessment of the obstructive potential of ABSH adjacent to a severely stenotic 
      valve can be challenging. We reviewed our experience with patients who underwent 
      concomitant septal myectomy at the time of AVR for severe aortic stenosis. 
      METHODS: During the 10-year period ending January 2009, 3,523 patients underwent 
      AVR for the primary indication of severe aortic stenosis. Forty-seven of these 
      patients underwent concomitant septal myectomy. Preoperative and postoperative 
      echocardiograms, operative data, hospital course, morbidity, and mortality were 
      assessed. RESULTS: The mean age of the group was 73 +/- 11 years. The mean aortic 
      valve area was 0.74 cm(2) preoperatively. On preoperative transthoracic 
      echocardiography, only 28% of the patients were considered to be at risk for 
      possible left ventricular outflow tract obstruction. The mean left ventricular 
      mass index decreased from 113.7 +/- 24.3 g preoperatively to 90.0 +/- 17.2 g at 1 
      year after the surgery (p < 0.001). The operative mortality was 2%. Complete 
      heart block was observed in 2 patients (4.2%), and no iatrogenic ventricular 
      septal defect was noted. CONCLUSIONS: A quantitative assessment of the 
      obstructive ABSH in the setting of severe aortic stenosis may be difficult 
      preoperatively. Surgeons should inspect left ventricular outflow tract for 
      possible obstructive ABSH at the time of AVR. Concomitant myectomy is a safe and 
      effective procedure without additional complications and should be considered for 
      patients with a preoperative or intraoperative diagnosis of ABSH even though 
      dynamic obstruction was not demonstrated.
CI  - 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights 
      reserved.
FAU - Kayalar, Nihan
AU  - Kayalar N
AD  - Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
FAU - Schaff, Hartzell V
AU  - Schaff HV
FAU - Daly, Richard C
AU  - Daly RC
FAU - Dearani, Joseph A
AU  - Dearani JA
FAU - Park, Soon J
AU  - Park SJ
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/diagnosis/*surgery
MH  - Cardiomyopathy, Hypertrophic/diagnosis/*surgery
MH  - Combined Modality Therapy
MH  - Comorbidity
MH  - Echocardiography
MH  - Echocardiography, Doppler, Color
MH  - Echocardiography, Transesophageal
MH  - Female
MH  - Heart Septum/*surgery
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Hypertrophy, Left Ventricular/diagnosis/*surgery
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/diagnosis
MH  - Retrospective Studies
MH  - Ventricular Outflow Obstruction/diagnosis/*surgery
EDAT- 2010/01/28 06:00
MHDA- 2010/02/18 06:00
CRDT- 2010/01/28 06:00
PHST- 2009/08/03 00:00 [received]
PHST- 2009/10/21 00:00 [revised]
PHST- 2009/10/23 00:00 [accepted]
PHST- 2010/01/28 06:00 [entrez]
PHST- 2010/01/28 06:00 [pubmed]
PHST- 2010/02/18 06:00 [medline]
AID - S0003-4975(09)02201-2 [pii]
AID - 10.1016/j.athoracsur.2009.10.065 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2010 Feb;89(2):459-64. doi: 10.1016/j.athoracsur.2009.10.065.