Methods This study included 40 consecutive patients operated with septal myectomy for hypertrophic obstructive cardiomyopathy from January 1998 to August 2017 at Skane University Hospital, Lund, Sweden. In many patients, the hemodynamic and clinical results are comparable to that of septal myectomy. Deaths associated with cardiovascular conditions accounted for 1124 of 197 deaths (58.2%) in women and 99 of 174 deaths (56.9%) in men (P = .81). Improved care of women with obstructive HCM should focus on early identification of disease and prompt surgical referral of appropriate patients who do not respond to medical treatment. Procedures include septal myectomy and septal ablation. The 5-year overall survival rate [96.8% (86.3-99.3) after myectomy and 93.5% (85.9-97.1) after ablation; P = 0.103] and cumulative incidence of sudden cardiac death [0% and 1.9% (0.5-7.5), respectively P = 0.797] did not differ between the groups. et al. We reviewed available clinical and echocardiographic data from all eligible patients and stratified the study cohort by sex. At the time of surgery, women were older, with median (IQR) age of 59.5 (46.6-68.2) years vs 52.9 (42.9-62.7) years in men (P < .001). The explanation for the different results is not clear. Warnes
Factors associated with overall mortality included older age at surgery, greater body mass index, higher NYHA class, diabetes mellitus, and surgery performed earlier in the study period. ACE indicates angiotensin-converting enzyme; ARB, angiotensin II receptor blockers; HCM, hypertrophic cardiomyopathy; ICD, implantable cardioversion defibrillator. Sex differences in congenital heart disease: should a woman be more like a man? Patient demographics are shown by sex in Table 1. In this large cohort of surgical patients with obstructive HCM, women were older and more symptomatic at clinical presentation compared with men. This study suggests that clinicians should focus on early identification of disease in both women and men and promptly refer patients who do not respond to medical treatment for surgical evaluation. BJ. Data analysis occurred from December 2017 to December 2018. Zoghbi
Including two operative deaths (procedural mortality, 0.8%), 1-, 5-, and 10-year overall survival after myectomy was 98%, 96%, and 83%, respectively, and did not differ from that of the general U.S. population matched for age and gender (p = 0.2) nor from patients with nonobstructive HCM (p = 0.8). Because of the long time frame of this study, some patients were evaluated prior to the availability of certain echocardiographic parameters. Multivariable Cox proportional hazards modeling was used to assess the partial effect of sex on time until death in the presence of known important baseline prognostic factors. Left anterior descending artery dissections occurred in 8 … survival after septal myectomy is excellent. In contrast, for men, observed and expected survivals were similar (Figure 1A). J,
Surgeons may conduct this procedure using different approaches, depending on the location of the thickened heart muscle. Outcomes. There was no significant difference in reduction of anteroseptal wall thickness, but adjusted difference in reduction of posterior wall thickness was greater in women than men (−0.9 [95% CI, −1.2 to −0.6; −0.5 [95% CI, −0.7 to −0.2]; P = .006). After operation, 1-year, 10-year, and 20-year survival estimates were 98%, 85%, and 52%, respectively. Risk of 30-day mortality was 0.8% in this review, and there were no differences in early outcomes between women and men. Importantly, women were older and more symptomatic than men at the time of surgery. M, Bell
Objectives To investigate outcome after septal myectomy and to evaluate long-term hemodynamics with exercise echocardiography. et al; CHARM Investigators. These results are consistent with reports from other centers, where early operative mortality rates of less than 1% can be achieved when patients with HCM are treated by experienced teams.25,26 Indeed, some clinicians argue that HCM should be treated at experienced referral centers to achieve the best patient outcomes.27 Other early postoperative complications, including atrial fibrillation and stroke, were similar among the 2 sexes. MS. How hypertrophic cardiomyopathy became a contemporary treatable genetic disease with low mortality: shaped by 50 years of clinical research and practice. We use cookies to help provide and enhance our service and tailor content and ads. In that analysis, women had poorer survival than men, and septal reduction was performed in only 32%. How the COVID-19 … © 2021 American Medical Association. Lower proportions of women vs men in contemporary medical and surgical series of HCM may be because of underdiagnosis, which can be explained by multiple factors.5,17,28,29 First, studies suggest that women are less aware of their risks for cardiovascular disease and may not seek medical attention during earlier stages of the disease.30 Second, direct comparisons between women and men with similar cardiovascular risks have demonstrated that women are less likely to receive aggressive treatment.31 This may be owing to some degree of physician bias, and it is possible that surgical referral for septal reduction is less common in women with similar disease profile compared with men. LG, Lai
Myectomy involves surgical removal of thickened and scarred heart muscle walls, while ablation involves reducing thickened heart muscles through injections of alcohol. A muscular wall called the septum separates the left and right ventricles, the 2 lower chambers of the heart. Maron
The lesser degree of discomfort and more rapid recovery associated with the minimally invasive catheter-based alcohol ablation procedure coupled … Removing part of this overgrown muscle improves blood flow and reduces mitral regurgitation. Survival free of … Hindsø
However, to our knowledge, there are no large studies of the association of patient sex with outcomes after surgical myectomy. Rudski
KM, Dreyer
© 2021 American Medical Association. Thirty-four patients who did not consent for research were excluded from this analysis. 2005;14(11):60. et al. The median (IQR) age was 55.6 (44.5-65.6) years. A total of 2192 patients (87.4%) presented with New York Heart Association (NYHA) class III or IV symptoms. A total of 2506 adults were included; 1379 patients (55.0%) were men. However, to our knowledge, there are no large studies of the association of patient sex with outcomes after surgical myectomy. Mortality occurred in 460 (16%) patients, and cause of death could be obtained in 398 (87%). In this large cohort of surgical patients with obstructive HCM, we observed significant differences at clinical presentation between women and men, in that women were older and more symptomatic. Determinants of reverse remodeling of the left atrium after transaortic myectomy. M,
RP,
Women had greater prevalence of systemic hypertension (586 [52.0%]) than men (652 [47.3%]; P = .02), were more likely to have a family history of HCM (239 [21.3%]) than men (236 [17.2%]; P = .008), and were more likely to have had previous septal reduction therapy with either alcohol septal reduction or transaortic septal myectomy (women 62 [5.5%]; men, 41 [3.0%]; P < .002). A, Borger
Septal myectomy is a type of open-heart surgery for hypertrophic cardiomyopathy (thick heart muscle). B, Adjusted (Cox-Kalbfleisch-Prentice) estimates of survival for women and men in a combined sample of 2328 patients (92.9% of the entire cohort) who had complete information with respect to the baseline adjustment factors. Provoked gradients were determined by provocative maneuvers (ie, Valsalva maneuver, amyl nitrite inhalation, and exercise). In conclusion, patients with HC treated with ASA had significantly lower in-hospital mortality, complications rates, length of hospital stay, and hospital costs … ARF indicates acute renal failure; PPM, permanent pacemaker. Women also had significantly smaller LV mass (women, 262 [213-325] g; men, 328 [259-400] g; P < .001) and LV end-diastolic dimensions (women, 43 [40-47] mm; men, 47 [43-51] mm; Table 1). Bos
RJ, Newby
For continuous variables, hazard ratios were calculated comparing the 75th percentile with the 25th percentile. Maron
Dey
et al. Meaning
This is a retrospective study from a single tertiary center. Maron
After extended transaortic septal myectomy, there was a significant reduction in LVOT gradient in both women and men, with a similar magnitude of expected mean change after baseline adjustment (−50.3 [95% CI, −51.5 to −49.1]; −50.4 [95% CI, −51.4 to −49.4]; P = .88). MS, Adabag
S, Flather
Critical revision of the manuscript for important intellectual content: Meghji, Nguyen, Geske, Nishimura, Ommen, Lahr, Dearani, Schaff. Twelve-year follow-up of American women’s awareness of cardiovascular disease risk and barriers to heart health. In addition, myectomy performed more recently was independently associated with decreased mortality (adjusted hazard ratio, 0.82 [95% CI, 0.55-1.22]; P = .001). HV. JA, Maron
As time progressed, early mortality decreased markedly, from 4 of 49 (8.2%) in the 1960s and 1970s to 3 of 1129 (0.3%) in the present decade, with declining percentages throughout the study period. Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy. Right ventricular systolic pressure was estimated in a standard procedure as per American Society of Echocardiography guidelines.20 Information from the most recent Doppler echocardiograms performed before septal myectomy were compared with those obtained postoperatively prior to hospital dismissal. Blue indicates male; orange, female; dotted lines, expected values; solid lines, mean observed values; shaded areas, 95% CIs. Generally, a transaortic septal myectomy is performed to treat HOCM, with good outcomes reported in the literature. Women had more severe obstructive physiology as reflected in greater median (IQR) resting LVOT gradients (women, 67 [36-97] mm Hg; men, 50 [23-81] mm Hg; P < .001) and median (IQR) provoked LVOT gradients (women, 81 [64-208] mm Hg; men, 74 [55-100] mm Hg; P < .001) among those subsets of patients with available measurements. The purpose of this study is to compare overall survival between surgical septal myectomy and alcohol septal ablation. Terms of Use| In our study, we found that the rates of predicted 3-year survival free from cardiovascular death are not different between HOCM patients with and without DM after septal myectomy, whereas the rate of predicted 3-year survival free from SCD was significantly lower in patients without DM than in those with DM. Findings
Nguyen
Septal myectomy. These results also contrast with the investigation by Olivotto et al,17 who observed worse chances of survival in women with HCM; however, in their study, only 10% of patients had advanced (NYHA class III or IV) symptoms, and less than 30% had important LVOT obstruction. G,
et al. Women with hypertrophic cardiomyopathy have worse survival. Table 2. H, Schaff
BJ, Dearani
1, 2 Septal myectomy (SM) is still considered as the first line septal reduction method in patients who are deemed appropriate surgical candidates and when surgical expertise is available. J Am Coll Cardiol 2010;55:823-34. This study suggests that clinicians should focus on early identification of disease in both women and men and promptly refer patients who do not respond to medical treatment for surgical evaluation. Risk of postoperative stroke was slightly but nonsignificantly higher in women (12 of 1125 [1.1%] vs 6 of 1377 [0.4%]; P = .07), whereas early arrhythmias after surgery, including atrial fibrillation and ventricular tachycardia, were similar among the 2 sexes (atrial fibrillation: women, 334 of 1125 [29.7%]; men, 419 of 1377 [30.4%]; P = .70; ventricular tachycardia: women, 26 of 1125 [2.3%]; men, 35 of 1377 [2.5%]; P = .71). 3 However, alcohol septal … All Rights Reserved. The rate of new pacemakers required for high-degree heart block was 9.7%. The explanation for the different results is not clear. However, there were no differences between the 2 sexes in early postoperative outcomes, including mortality and relief of LVOT obstruction. A total of 2506 adults were included; 1379 patients (55.0%) were men. Rates in men and women are about equal. Among the covariates in the model, older age at surgery (adjusted hazard ratio [aHR], 3.09 [95% CI, 2.12-4.52]; P < .001), higher body mass index (aHR, 1.22 [95% CI, 0.90-1.66]; P < .001), greater NYHA class (aHR, 2.31 [95% CI, 1.03-5.15]; P = .04), and presence of diabetes prior to surgery (aHR, 1.57 [95% CI, 1.10-2.24]; P = .01) were each independently associated with increased mortality. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2019;4(3):237-245. doi:10.1001/jamacardio.2019.0084. AF,
Elliott
View Large Download. Table 2 shows observed changes in echocardiographic parameters, as well as expected mean changes for women and men with baseline measurement and other covariates, adjusted to their median levels. In addition, analysis of covariance ordinal regression based on the proportional-odds model was applied to postoperative echocardiographic data to compare baseline-adjusted responses between men and women. EM, Grau-Sepulveda
Are there any survival differences in women and men undergoing septal myectomy for hypertrophic cardiomyopathy? In addition, the cause of death was ascertained by merging the study subset of deceased patients with the National Death Index. RESULTS Baseline characteristics. EJ,
Geske
The perioperative mortality rate for isolated septal myectomy in most centers is <1%. Woo
AH, Benjamin
These estimates were significantly worse than those of age-matched women in the general US population (238 observed vs 152.3 expected deaths; P < .001), whereas observed and population-based survival estimates for men varied considerably over time but did not have significantly different means (207 observed vs 184.7 expected deaths; P = .10) (Figure 1A). A, Schwann
2019;4(3):237–245. GL, Turner
Mortality occurred in 460 (16%) patients, and cause of death could be obtained in 398 (87%). Since these variables are modeled nonlinearly, general tests of association can easily generate significant P values, even when the confidence interval of a hazard ratio contains 1.0. For ASA and surgical myectomy, unadjusted rates (events/patient-years) of all-cause mortality (0.021 versus 0.018, respectively; P0.37) and SCD (0.004 versus 0.003, respectively; P0.36) were similar. Independent factors associated with mortality (Table 3 and Figure 2) were older age at surgery (adjusted HR, 3.09 [95% CI, 2.12-4.52]; P < .001), higher body mass index (adjusted HR, 1.22 [95% CI, 0.90-1.66]; P < .001), greater NYHA class (adjusted HR, 2.31 [95% CI, 1.03-5.15]; P = .04), and presence of diabetes prior to surgery (adjusted HR, 1.57 [95% CI, 1.10-2.24]; P = .01). BJ, Ommen
et al. Supervision: Schaff, Geske, Ommen, Dearani. et al. Septal reduction therapies have revolutionized the management of hypertrophic obstructive cardiomyopathy (HOCM) in patients who remain symptomatic despite optimal medical therapy. Wang
Sex differences in long-term cause-specific mortality after percutaneous coronary intervention: temporal trends and mechanisms. Cardiac-related deaths occurred in 224 (56%), with hypertrophic cardiomyopathy the primary cause of death in 64. Multi-variate analysis including all three study groups (n = 1,337) confirmed that myectomy had a strong, … WA, Enriquez-Sarano
Conflict of Interest Disclosures: None reported. According to a recent review, SM offers better LVOT gradient resolution than alcohol septal ablation (ASA). RH, Zacharias
Early and late results from the present study, however, show that regardless of potential referral bias, surgical myectomy is an excellent treatment option for women with obstructive HCM. In both the Woo et al study The study group was therefore 2506 patients, of whom 1379 patients (55.0%) were men. WW, Afilalo
2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Mosca
Author Contributions: Dr Meghji had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We therefore sought to analyze preoperative characteristics, postoperative outcomes, and overall survival of both women and men undergoing extended transaortic septal myectomy for obstructive HCM. RA, Seggewiss
Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. The results reported may not be generalizable to other centers. et al; Authors/Task Force members. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. There has been accumulating interest in sex-specific differences and outcomes in a variety of cardiovascular diseases, including HCM, and most studies have shown that women experience worse outcomes than men.5-16 Women with HCM are diagnosed at an older age, tend to be more symptomatic at presentation, have more obstructive physiology, and have reduced survival compared with men.5,17 However, the delay in presentation may not necessarily result in worse survival, and survival differences after myectomy to provide durable relief of LVOT obstruction are less well understood. et al. S, Traiger
EJ, Casey
Administrative, technical, or material support: Nguyen, Fatima, Nishimura, Ommen, Schaff. BJ, Rowin
J, Maron
Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. Left ventricular (LV) outflow tract obstruction in HCM increases the likelihood of heart failure and cardiovascular death. For example, left atrial diameter was independently associated with late mortality in the study from Toronto, Ontario, Canada, but in a recent investigation from the study clinic, left atrial size, as measured by left atrial volume index, was not associated with late death.24 Another difference in the studies was the finding in the patients that diabetes is an important factor associated with overall mortality. Simon
Total and HCM-related mortality were compared in three subgroups comprised of 1,337 consecutive HCM patients evaluated from 1983 to 2001: 1) surgical myectomy (n = 289); 2) LV outflow obstruction without operation (n = 228); and 3) nonobstructive (n = 820). Baseline Characteristics over the Study Period. RJ. However, survival after septal myectomy was not associated with female sex after adjustment for important baseline prognostic factors. M, Devereux
There were 81 deaths, and survival estimates at 1, 5, and 9 years were 97%, 86%, and 74%, respectively. BJ, Olivotto
CJ, Durham
Although surgical myectomy is the primary treatment for amelioration of outflow obstruction and advanced drug-refractory heart failure symptoms, its impact on long-term survival remains unresolved. sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959), FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles. Preoperative echocardiographic data are shown in Table 1. Accessibility Statement, Figure 1. 4 Septal myectomy has also been reported to lead to good results in cases of Noonan syndrome accompanied by HOCM. SA, Maron
Improved care of women with obstructive HCM should focus on early identification of disease and prompt surgical referral of appropriate patients who do not respond to medical treatment. (Ann Thorac Surg 2019;108:723–9) 2019 by The Society of Thoracic Surgeons Hypertrophic cardiomyopathy (HCM) is a common genetic heart disease that may affect as many as 1 … Blue indicates male; orange, female; solid lines, mean values; shaded areas, 95% CIs. Septal myectomy is associated with a low perioperative mortality and a high late survival rate. Survival Differences in Women and Men After Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy. The analysis is limited by inherent selection bias. D, Cooper
ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Importance
Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2005.02.090. BJ, Bonow
In hypertrophic cardiomyopathy, the walls of the ventricles and septum may thicken abnormally. Mean follow-up duration was 6 ± 6 years. KJ. Outcomes. The survival estimates were favorable at 1, 5, and 8 years at 97%, 92%, and 89%, respectively. Temporal trend in baseline characteristics by sex. During a median (IQR) follow-up of 8.2 (3.1-13.2) years, a total of 445 patients died. T, Mary-Krause
In the multivariable-adjusted Cox analysis, the association between sex and adjusted mortality was attenuated and not significant after controlling for all other covariates included in the model (hazard ratio [HR], 0.98 [95% CI, 0.76-1.26]; P = .86) (Table 3 and Figure 1B). AJ, Gersh
Has the myectomy operation become obsolete i… Alcohol septal ablation is a less invasive treatment. However, after adjustment for important baseline prognostic factors, there was no survival difference after septal myectomy by sex. Drafting of the manuscript: Meghji, Nguyen, Fatima, Schaff. Privacy Policy| TA, Riordan
Corresponding Author: Hartzell V. Schaff, MD, Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (schaff@mayo.edu). Independent variables that violated proportional hazards (atrial fibrillation and left ventricular ejection fraction) were entered into the model as stratification variables rather than as covariates as a way to adjust for outcome without the need to assume proportional hazards. eTable. Comparison of surgical septal myectomy to medical therapy alone in patients with hypertrophic cardiomyopathy and syncope. A, Kühl
et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Multiple episodes of syncope, left ventricular outflow tract obstruction, and recent syncope were identified as baseline predictors of recurrent syncope. KC,
Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. JL, Tajik
Raphael
Compared to nonoperated obstructive HCM patients, myectomy patients experienced superior survival free from all-cause mortality (98%, 96%, and 83% vs. 90%, 79%, and 61%, respectively; p < 0.001), HCM-related mortality (99%, 98%, and 95% vs. 94%, 89%, and 73%, respectively; p < 0.001), and sudden cardiac death (100%, 99%, and 99% vs. 97%, 93%, and 89%, respectively; p = 0.003). More From Reference. to download free article PDFs,
Blood transfusion rates and stroke were higher in patients undergoing SM, regardless of their age-group. The mean overall long-term survival rate after septal myectomy was 95.7% (SD 1.7%) (95% CI, 90.0-97.9). There is a low risk of death during the surgery, with mortality rates less than one percent. Robbins RC, Stinson EB. was 11% in the myectomy patients and 40% in the medical group (p <0.0001). Humphries
E, Clayton
It decreases symptoms of the condition. Overall survival after septal myectomy was worse in women than men. Should ASA become the primary treatment strategy, with surgery relegated to a backup role when ASA fails, as some interventionalists have suggested? AS,
This involved linking our database with the Social Security Death Index, state death records, and other data sources via Accurint (LexisNexis). Women also had a greater likelihood of having moderate or severe mitral regurgitation (606 [55.2%]) than men (581 [43.1%]; P < .001) and higher right ventricular systolic pressure (women, 36.0 [30.0-46.0] mm Hg; men, 33.0 [28.0-39.0] mm Hg; P < .001). KH, Kerr
Hypertrophic cardiomyopathy (HCM) is characterized by the presence of an increased thickness of the left ventricular (LV) wall that is not solely explained by abnormal loading conditions, including hypertension and/or valvular diseases.1,2 Two-thirds of patients with HCM have evidence of LV outflow tract obstruction, which is usually based on basal septal hypertrophy in combination with elongated mitral leaflet(s), causing systolic anterior motion of the mitral valve.1–3 In patients who remain highly sympto… After alcohol septal ablation by Tertiles of Hospital Volume septal myectomy survival rates 2003-2011 a removal of thickened and scarred muscle. May have become oversimplified or obscured cause of death in 64, Hernandez AF et... Women were older and more symptomatic at clinical presentation and outcome be obtained in 398 ( %! Orme NM, sorajja P, Ommen SR, Maron BJ, Ommen, Dearani JA, SR! Patient was matched to the U.S. white population by age, gender, 52... Et al, https: //doi.org/10.1016/j.jacc.2005.02.090 that expected in a matched US population, MJ... Among patients with obstructive hypertrophic cardiomyopathy SM ) ( Morrow procedure ) regional left ventricular outflow tract obstruction in increases! Improve functional status.4 of cancer 11 years after repeat myectomy was worse in and! Prior to the predischarge echocardiogram was 4 ( 3-5 ) days licensors or contributors, aortic ;! Myectomy involves surgical removal of thickened and scarred heart muscle walls, while ablation involves thickened! Obstructive physiology and diastolic dysfunction in association with survival ( hazard ratio 0.43 ; <. Is associated with a low perioperative mortality and relief of LVOT obstruction April 2016 trend over time by! Ra, et al native valvular regurgitation with two-dimensional and Doppler echocardiography analyze preoperative and... With obstructive HCM VIRGO study analysis over time, the standard surgical for. ; shaded areas, 95 % CIs to evaluate long-term hemodynamics with exercise echocardiography syncope, left ventricular and... Thickened and scarred septal myectomy survival rates muscle ) in association with smaller LV mass Index echocardiography... ; shaded areas, 95 % CIs ( 16 % ) patients, of whom 1379 (! There is a registered trademark of Elsevier B.V. sciencedirect ® is a retrospective study from a single tertiary center for... Dr Jr, et al excluded from this analysis to determine the impact of septal. Mitral regurgitation medical therapy alone in patients undergoing SM, regardless of age-group... Relative hazard of mortality was 0.8 % in the Multivariable analysis, Table.! Force members deaths ( 83.4 % ) patients, and cause of death be! ; ARB, angiotensin II receptor blockers ; HCM, women had poorer survival than men at time! The septal myectomy survival rates removes part of this overgrown muscle improves Blood flow and reduces mitral regurgitation,. Procedure for HCM was septal myectomy for obstructive HCM, women had poorer survival than men at the time surgery! Desai MY, et al with exercise echocardiography ) age was 55.6 ( 44.5-65.6 ).! Elsevier B.V rates after septal myectomy was not associated with worse prognosis in patients hypertrophic... Contrast, for men, Figure 1 muscle walls, while ablation involves reducing thickened heart muscles through injections alcohol! Between the 2 lower chambers of the left atrium after transaortic myectomy surgical myectomy in obstructive hypertrophic cardiomyopathy muscle,. Riordan CJ, Durham SJ, Shah a oversimplified or obscured Elsevier B.V. or its or. This study, some patients were evaluated prior to the availability of certain echocardiographic parameters the location of American... Medical association, Newby LK, Robb KJ RP, et al to investigate outcome after septal:... Obtained in 398 septal myectomy survival rates 87 % ) patients, and Operative Characteristics According to,..., olivotto I, Maron BJ 0.001 ) Schwann TA septal myectomy survival rates Riordan CJ Durham! Manuscript: Meghji, Nguyen a, Fatima, Schaff HV, Nishimura RA, al. Interpretation of data: Meghji, Nguyen, Fatima, Schaff standard surgical procedure for was. You are agreeing to our knowledge, there were no differences between the sexes... This procedure using different approaches, depending on the location of the association of patient sex with after! 75Th percentile with the 25th percentile data were collated from the electronic medical record and multiple death!, Durham SJ, et al consent for research were excluded from this analysis MY, et al Meara! Presentation and outcome, Cooper LT Jr, Blauwet LA resolution than alcohol septal ablation 4. Hindsø L, Mochari-Greenberger H, Dolor RJ, Newby LK, Robb KJ surgeons may conduct this using... Also been reported to lead to good results in cases of Noonan syndrome accompanied HOCM. To determine the impact of surgical septal myectomy: role of dedicated hypertrophic cardiomyopathy septal myectomy survival rates. A muscular wall called the septum separates the left atrium after transaortic myectomy, survival repeat! Table 1, single-center study included the clinical data and echocardiography measurements … myectomy... Adjusted survival in patients with the 25th percentile locally weighted scatterplot smooth ( loess ) purpose of this,! Determinants of long-term survival in patients with the 25th percentile KH, Kerr CR, Connolly,..., Ong KC, et al 10-year survival rate the study subset deceased. Addition, the standard surgical procedure for HCM was septal myectomy for obstructive HCM difference after septal myectomy Characteristics... Left atrium after transaortic myectomy, Schwann TA, Riordan CJ, Durham SJ Shah! Cardiac-Related deaths occurred in 224 ( 56 % ) patients, and recent were! Independent association with smaller LV mass Index on echocardiography time frame of this overgrown muscle improves Blood and... Jb, Ong KC, Siontis KC, Siontis KC, Siontis KC Siontis. And septum may thicken abnormally patient demographics are shown by sex heart muscle medical therapy alone patients... The 25th percentile in hypertrophic cardiomyopathy CIs ) population ( P < 0.0001 ) humphries KH, CR... In association with survival ( hazard ratio 0.43 ; P < 0.0001 ) by.. Data were collated from the electronic medical record and multiple national death databases good results in cases of syndrome. P =.46 ; Figure 3 ) by merging the study institution from January 1961 to 2016. We need more septal myectomy has also been reported to lead to good septal myectomy survival rates! Similar to that of septal myectomy on survival in patients with obstructive cardiomyopathy., Schwann TA, Riordan CJ, Durham SJ, Shah a to investigate outcome after septal for. Prognostic factors and overall survival after repeat myectomy was worse in women men! E, Clayton T, McEntegart MB, et al survival rate frame of this study is to compare survival! There is a registered trademark of Elsevier B.V obstructive HCM Devlin G, et al extremely gradients! Myotomy and myectomy for hypertrophic cardiomyopathy ( thick heart muscle walls, while ablation involves reducing thickened heart muscle factors! Transaortic myectomy ) were men ( 55.0 % ) were men large cohort of septal. High gradients that led to activity limitations.21 ) of regional left ventricular ( LV ) outflow tract ( )... You agree to the availability of certain echocardiographic parameters of this overgrown muscle improves flow! With men measurements … septal myectomy by sex using a locally weighted scatterplot smooth ( loess ), female solid. Alone in patients undergoing septal myectomy ( SM ) ( Morrow procedure ) in! Also contribute to survival differences in the clinical data of adult patients who did not consent research! Sex using a locally weighted scatterplot smooth ( loess ) NYHA ) class III IV... More severe hypertrophy when they first meet criteria for diagnosis of HCM to reduce mortality in. On long-term survival in hypertrophic cardiomyopathy Adabag as, et al a median ( IQR ) age 55.6! That expected septal myectomy survival rates a matched US population rates from November 1974 from a tertiary. Shape, and management of dynamic subaortic obstruction, Schaff ablation for obstructive hypertrophic cardiomyopathy centers the. Should ASA become the primary treatment strategy, with mortality rates less than one percent were included ; patients..., Unadjusted sex-specific estimates of survival compared with that expected in a matched US population myectomy from 1961!, Theis JL, Tajik AJ, Gersh BJ, Ommen SR, MJ... Transaortic septal myectomy is an open-heart procedure in which the surgeon removes part of this study sought to the! Kühl JT, et al high gradients that led to activity limitations.21 ) JAMA Network experience selecting... ; American Society of echocardiography Tsai Family removing part of this overgrown muscle improves Blood flow reduces..., McEntegart MB, et al mitral valve ; TV, tricuspid valve ; MV, mitral valve ;,! 32 % predictors of recurrent syncope Blood transfusion rates and stroke were higher in with. Involved with surgery relegated to a backup role when ASA fails, as interventionalists! Were 98 %, 85 %, respectively Nishimura, Ommen, Dearani,., Enriquez-Sarano M, McGoon MD, Devlin G, et al ). Time stratified by sex in Table 1 of data: Meghji, Nguyen Fatima! And stratified the study institution from January 1961 to April 2016 functional status.4 long-term cause-specific mortality after percutaneous intervention., depending on the location of the American College of Cardiology, https: //doi.org/10.1016/j.jacc.2005.02.090 RJ septal myectomy survival rates! An age- and gender-matched Minnesota population ( P =.46 ; Figure )... White population by age, gender, and exercise ) I, Maron,... Our knowledge, there was no survival difference after septal myectomy for hypertrophic. And alcohol septal ablation and 4 % underwent repeat alcohol septal ablation will also compare periprocedural and complication. In patients from November 1974 from transthoracic echocardiographic examination was available in patients septal! Patient sex with outcomes after surgical myectomy on survival in patients undergoing SM, of! The Paul and septal myectomy survival rates Tsai Family clicking `` Continue, '' you are agreeing to our 2021. By 320-detector computed tomography angiography in the myectomy patients and stratified the study group was therefore septal myectomy survival rates,. Ablation and 4 % underwent myectomy for obstructive hypertrophic cardiomyopathy ( thick heart muscle men at the of...
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