PMID- 25238885
OWN - NLM
STAT- MEDLINE
DCOM- 20160127
LR  - 20190318
IS  - 1876-4738 (Electronic)
IS  - 0914-5087 (Linking)
VI  - 66
IP  - 1
DP  - 2015 Jul
TI  - Long-term outcomes of septal reduction for obstructive hypertrophic 
      cardiomyopathy.
PG  - 57-62
LID - S0914-5087(14)00255-X [pii]
LID - 10.1016/j.jjcc.2014.08.010 [doi]
AB  - BACKGROUND: Surgical myectomy and alcohol septal ablation (ASA) aim to decrease 
      left ventricular outflow tract (LVOT) gradient in hypertrophic cardiomyopathy 
      (HCM). Outcome of myectomy beyond 10 years has rarely been described. We describe 
      20 years of follow-up of surgical myectomy and 5 years of follow-up for ASA 
      performed for obstructive HCM. METHODS: We studied 171 patients who underwent 
      myectomy for symptomatic LVOT obstruction between 1972 and 2006. In addition, we 
      studied 52 patients who underwent ASA for the same indication and who declined 
      surgery. Follow-up of New York Heart Association (NYHA) functional class, 
      echocardiographic data, and vital status were obtained from patient records. 
      Mortality rates were compared with expected mortality rates of age- and 
      sex-matched populations. RESULTS: Surgical myectomy improved NYHA class 
      (2.74+/-0.65 to 1.54+/-0.74, p<0.001), reduced resting gradient (67.4+/-43.4mmHg to 
      11.2+/-16.4mmHg, p<0.001), and inducible LVOT gradient (98.1+/-34.7mmHg to 
      33.6+/-34.9mmHg, p<0.001). Similarly, ASA improved functional class (2.99+/-0.35 to 
      1.5+/-0.74, p<0.001), resting gradient (67.1+/-26.9mmHg to 23.9+/-29.4mmHg, p<0.001) 
      and provoked gradient (104.4+/-34.9mmHg to 35.5+/-38.6mmHg, p<0.001). Survival after 
      myectomy at 5, 10, 15, and 20 years of follow-up was 92.9%, 81.1%, 68.9%, and 
      47.5%, respectively. Of note, long-term survival after myectomy was lower than 
      for the general population [standardized mortality ratio (SMR)=1.40, p<0.005], 
      but still compared favorably with historical data from non-operated HCM patients. 
      Survival after ASA at 2 and 5 years was 97.8% and 94.7%, respectively. Short-term 
      (5 year) survival after ASA (SMR=0.61, p=0.48) was comparable to that of the 
      general population. CONCLUSION: Long-term follow-up of septal reduction 
      strategies in obstructive HCM reveals that surgical myectomy and ASA are 
      effective for symptom relief and LVOT gradient reduction and are associated with 
      favorable survival. While overall prognosis for the community HCM population is 
      similar to the general population, the need for surgical myectomy may identify a 
      sub-group with poorer long-term prognosis. We await long-term outcomes of more 
      extensive myectomy approaches adopted in the past 10 years at major institutions.
CI  - Copyright (c) 2015. Published by Elsevier Ltd.
FAU - Sedehi, Daniel
AU  - Sedehi D
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Finocchiaro, Gherardo
AU  - Finocchiaro G
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA. Electronic address: gherardobis@yahoo.it.
FAU - Tibayan, Yen
AU  - Tibayan Y
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Chi, Jeffrey
AU  - Chi J
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Pavlovic, Aleksandra
AU  - Pavlovic A
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Kim, Young M
AU  - Kim YM
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Tibayan, Frederick A
AU  - Tibayan FA
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Reitz, Bruce A
AU  - Reitz BA
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Robbins, Robert C
AU  - Robbins RC
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Woo, Joseph
AU  - Woo J
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Ha, Richard
AU  - Ha R
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Lee, David P
AU  - Lee DP
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA.
FAU - Ashley, Euan A
AU  - Ashley EA
AD  - Division of Cardiovascular Medicine, Stanford University Medical Center, 
      Stanford, CA, USA. Electronic address: euan@stanford.edu.
LA  - eng
PT  - Journal Article
DEP - 20140918
PL  - Netherlands
TA  - J Cardiol
JT  - Journal of cardiology
JID - 8804703
SB  - IM
MH  - California
MH  - Cardiomyopathy, Hypertrophic/diagnostic 
      imaging/mortality/physiopathology/*surgery
MH  - Catheter Ablation
MH  - Echocardiography
MH  - Female
MH  - Heart Septum/*surgery
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Survival Analysis
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Alcohol septal ablation
OT  - Hypertrophic cardiomyopathy
OT  - Long-term outcomes
OT  - Septal myectomy
EDAT- 2014/09/23 06:00
MHDA- 2016/01/28 06:00
CRDT- 2014/09/21 06:00
PHST- 2013/11/25 00:00 [received]
PHST- 2014/07/16 00:00 [revised]
PHST- 2014/08/14 00:00 [accepted]
PHST- 2014/09/21 06:00 [entrez]
PHST- 2014/09/23 06:00 [pubmed]
PHST- 2016/01/28 06:00 [medline]
AID - S0914-5087(14)00255-X [pii]
AID - 10.1016/j.jjcc.2014.08.010 [doi]
PST - ppublish
SO  - J Cardiol. 2015 Jul;66(1):57-62. doi: 10.1016/j.jjcc.2014.08.010. Epub 2014 Sep 
      18.