PMID- 36650965
OWN - NLM
STAT- MEDLINE
DCOM- 20230306
LR  - 20230306
IS  - 0529-5815 (Print)
IS  - 0529-5815 (Linking)
VI  - 61
IP  - 3
DP  - 2023 Mar 1
TI  - [Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year 
      single-center experience of 421 cases].
PG  - 201-208
LID - 10.3760/cma.j.cn112139-20221129-00505 [doi]
AB  - Objectives: To examine the short-term and mid-term effects of surgical treatment 
      of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The 
      perioperative data and short-term follow-up outcomes of 421 patients with 
      obstructive HCM who received surgical treatment at Department of Cardiac Surgery, 
      Zhongshan Hospital, Fudan University from January 2017 to December 2021 were 
      analyzed retrospectively. There were 207 males and 214 females, aged (56.5+/-11.7) 
      years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) 
      classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases 
      in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 
      257 patients had moderate or more mitral regurgitation with 56 patients suffering 
      from intrinsic mitral valve diseases. All procedures were completed by a 
      multidisciplinary team, including professional echocardiologists involving in 
      preoperative planning for proper mitral valve management strategies and 
      intraoperative monitoring. A total of 338 patients underwent septal myectomy 
      alone, and 59 patients underwent mitral valve surgery along with myectomy. A 
      single transaortic approach was used in 355 patients, and a right atrial-atrial 
      septal/atrial sulcus approach was used in 51 other patients. Long-handled 
      minimally invasive surgical instruments were used for the procedures. Student t 
      test, Wilcoxon rank sum test, chi(2) test or Fisher exact test were used to compare 
      the data before and after surgery. Results: The aortic cross-clamping time of 
      septal myectomy alone was (34.3+/-8.5) minutes (range: 21 to 94 minutes). Eighteen 
      patients had intraoperative adverse events and underwent immediate reoperation, 
      including residual obstruction (10 patients), left ventricular free wall rupture 
      (4 patients), ventricular septal perforation (3 patients), and aortic valve 
      perforation (1 patient). Four patients died during hospitalization, and 11 
      patients developed complete atrioventricular block requiring permanent pacemaker 
      implantation. After discharge, 384 (92.1%) patients received a follow-up visit 
      with a median duration of 9 months. All follow-up patients survived with 
      significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 
      patients in class Ⅱ (chi(2)=662.73, P<0.01 as compared to baseline). At 6 months 
      after surgery, follow-up echocardiography showed that the thickness of the 
      ventricular septum ((13.6+/-2.5) mm vs. (18.2+/-3.0) mm, t=23.51, P<0.01) and the 
      peak left ventricular outflow tract gradient ((12.0+/-6.3) mmHg vs. (93.4+/-19.8) 
      mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than 
      baseline values. Conclusion: The construction of the surgical team (including 
      echocardiography experts), proper mitral valve management strategies, 
      identification and management of sub-mitral-valve abnormalities, and application 
      of long-handled minimally invasive surgical instruments are important for the 
      successful implementation of septal myectomy with satisfactory short-and 
      medium-term outcomes.
FAU - Liu, F Y
AU  - Liu FY
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
FAU - Ji, Q
AU  - Ji Q
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
FAU - Wang, Y L
AU  - Wang YL
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
FAU - Chen, J M
AU  - Chen JM
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
FAU - Dong, L L
AU  - Dong LL
AD  - Department of Cardiac Ultrasound Diagnosis, Zhongshan Hospital, Fudan University, 
      Shanghai 200032, China.
FAU - Ding, W J
AU  - Ding WJ
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
FAU - Lai, H
AU  - Lai H
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
FAU - Wang, C S
AU  - Wang CS
AD  - Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 
      Municipal Institute for Cardiovascular Diseases, Shanghai 200032, China.
LA  - chi
PT  - English Abstract
PT  - Journal Article
PL  - China
TA  - Zhonghua Wai Ke Za Zhi
JT  - Zhonghua wai ke za zhi [Chinese journal of surgery]
JID - 0153611
SB  - IM
MH  - Male
MH  - Female
MH  - Humans
MH  - Retrospective Studies
MH  - *Atrial Fibrillation
MH  - Treatment Outcome
MH  - *Cardiomyopathy, Hypertrophic/surgery
MH  - *Mitral Valve Insufficiency/surgery
MH  - *Ventricular Septum
EDAT- 2023/01/19 06:00
MHDA- 2023/03/07 06:00
CRDT- 2023/01/18 02:42
PHST- 2023/01/19 06:00 [pubmed]
PHST- 2023/03/07 06:00 [medline]
PHST- 2023/01/18 02:42 [entrez]
AID - 10.3760/cma.j.cn112139-20221129-00505 [doi]
PST - ppublish
SO  - Zhonghua Wai Ke Za Zhi. 2023 Mar 1;61(3):201-208. doi: 
      10.3760/cma.j.cn112139-20221129-00505.