PMID- 29148156
OWN - NLM
STAT- MEDLINE
DCOM- 20181211
LR  - 20181211
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 20
IP  - 2
DP  - 2018 Feb
TI  - Long-term outcomes for different surgical strategies to treat left ventricular 
      outflow tract obstruction in hypertrophic cardiomyopathy.
PG  - 398-405
LID - 10.1002/ejhf.1038 [doi]
AB  - AIMS: Surgical intervention is used to treat dynamic left ventricular outflow 
      tract obstruction (LVOTO) in hypertrophic cardiomyopathy. This study assesses the 
      effect of different surgical strategies on long-term mortality and morbidity. 
      METHODS AND RESULTS: In total, 347 patients underwent surgical intervention for 
      LVOTO (1988-2015). Group A (n = 272) underwent septal myectomy; Group B (n = 33), 
      septal myectomy and mitral valve (MV) repair; Group C (n = 22), myectomy and MV 
      replacement; and Group D (n = 20), MV replacement alone. Median follow-up was 
      5.2 years (interquartile range 1.9-7.9). The mean resting LVOT gradient improved 
      post-operatively from 71.9 +/- 39.6 mmHg to 13.4 +/- 18.5 mmHg (P < 0.05). Overall, 
      72.4% of patients improved by >1 New York Heart Association (NYHA) class; 58.9% 
      of patients undergoing MV replacement alone did not improve their NYHA class. 
      There were 5 perioperative deaths and 20 late deaths (>30 days). Survival rates 
      at 1, 5 and 10 years respectively were 98.4, 96.9, 91.9% in Group A; 97.0, 92.4, 
      61.6% in Group B; 100.0, 100.0, 55.6% in Group C; and 94.7, 85.3, 85.3% in Group 
      D (log-rank, P < 0.05). Long-term (>30 days) complications included atrial 
      fibrillation (29.6%), transient ischaemic attack/stroke (2.4%) and heart failure 
      hospitalisation (3.2%). There were 16 repeat surgical interventions at 3.0 years. 
      CONCLUSION: Septal myectomy is a safe procedure resulting in symptomatic 
      improvement in the majority of patients. The annual incidence of non-fatal 
      disease-related complications after surgical treatment of LVOTO is relatively 
      high. Patients who underwent MV replacements had poorer outcomes with less 
      symptomatic benefit in spite of a similar reduction in LVOT gradients.
CI  - (c) 2017 The Authors. European Journal of Heart Failure (c) 2017 European Society of 
      Cardiology.
FAU - Collis, Richard
AU  - Collis R
AD  - Institute of Cardiovascular Science, University College London, London, UK.
AD  - Barts Heart Centre, St Bartholomew's Hospital, London, UK.
FAU - Watkinson, Oliver
AU  - Watkinson O
AD  - Institute of Cardiovascular Science, University College London, London, UK.
AD  - Barts Heart Centre, St Bartholomew's Hospital, London, UK.
FAU - O'Mahony, Constantinos
AU  - O'Mahony C
AD  - Barts Heart Centre, St Bartholomew's Hospital, London, UK.
FAU - Guttmann, Oliver P
AU  - Guttmann OP
AD  - Barts Heart Centre, St Bartholomew's Hospital, London, UK.
FAU - Pantazis, Antonis
AU  - Pantazis A
AD  - Royal Brompton Hospital, Chelsea, London, UK.
FAU - Tome-Esteban, Maria
AU  - Tome-Esteban M
AD  - Cardiology Clinical Academic Group, St George's University Hospitals NHS 
      Foundation Trust, Tooting, London, UK.
FAU - Tsang, Victor
AU  - Tsang V
AD  - Barts Heart Centre, St Bartholomew's Hospital, London, UK.
FAU - Chandrasekaran, Venkatachalam
AU  - Chandrasekaran V
AD  - Cardiology Clinical Academic Group, St George's University Hospitals NHS 
      Foundation Trust, Tooting, London, UK.
FAU - McGregor, Christopher G A
AU  - McGregor CGA
AD  - Institute of Cardiovascular Science, University College London, London, UK.
FAU - Elliott, Perry M
AU  - Elliott PM
AD  - Institute of Cardiovascular Science, University College London, London, UK.
AD  - Barts Heart Centre, St Bartholomew's Hospital, London, UK.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20171116
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
CIN - Eur J Heart Fail. 2018 Feb;20(2):406-408. PMID: 29164742
MH  - Adult
MH  - Cardiac Surgical Procedures/*methods
MH  - Cardiomyopathy, Hypertrophic/complications/diagnosis/*surgery
MH  - Echocardiography
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/epidemiology
MH  - *Practice Guidelines as Topic
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Treatment Outcome
MH  - United Kingdom/epidemiology
MH  - Ventricular Outflow Obstruction/diagnosis/etiology/*surgery
OTO - NOTNLM
OT  - Hypertrophic cardiomyopathy
OT  - Left ventricular outflow tract obstruction
OT  - Septal myectomy
EDAT- 2017/11/18 06:00
MHDA- 2018/12/12 06:00
CRDT- 2017/11/18 06:00
PHST- 2017/02/28 00:00 [received]
PHST- 2017/08/25 00:00 [revised]
PHST- 2017/09/01 00:00 [accepted]
PHST- 2017/11/18 06:00 [pubmed]
PHST- 2018/12/12 06:00 [medline]
PHST- 2017/11/18 06:00 [entrez]
AID - 10.1002/ejhf.1038 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2018 Feb;20(2):398-405. doi: 10.1002/ejhf.1038. Epub 2017 Nov 
      16.