Hypertrophic Obstructive Cardiomyopathy: Surgical Myectomy and Septal Ablation

Published on Sep 15, 2017in Circulation Research17.367
· DOI :10.1161/CIRCRESAHA.116.309348
Rick A. Nishimura103
Estimated H-index: 103
(Mayo Clinic),
Hubert Seggewiss1
Estimated H-index: 1
(Mayo Clinic),
Hartzell V. Schaff132
Estimated H-index: 132
(Mayo Clinic)
Sources
Abstract
Hypertrophic cardiomyopathy is a genetic disorder characterized by marked hypertrophy of the myocardium. It is frequently accompanied by dynamic left ventricular outflow tract obstruction and symptoms of dyspnea, angina, and syncope. The initial therapy for symptomatic patients with obstruction is medical therapy with β-blockers and calcium antagonists. However, there remain a subset of patients who have continued severe symptoms, which are unresponsive to medical therapy. These patients can be treated with septal reduction therapy, either surgical septal myectomy or alcohol septal ablation. When performed by experienced operators working in high-volume centers, septal myectomy is highly effective with a >90% relief of obstruction and improvement in symptoms. The perioperative mortality rate for isolated septal myectomy in most centers is
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201129.69Circulation
14 Authors (Rick A. Nishimura)
References111
Newest
#1Ali J. Marian (Brigham and Women's Hospital)H-Index: 64
#2Eugene Braunwald (The Texas Heart Institute)H-Index: 1
Hypertrophic cardiomyopathy (HCM) is a genetic disorder that is characterized by left ventricular hypertrophy unexplained by secondary causes and a nondilated left ventricle with preserved or increased ejection fraction. It is commonly asymmetrical with the most severe hypertrophy involving the basal interventricular septum. Left ventricular outflow tract obstruction is present at rest in about one third of the patients and can be provoked in another third. The histological features of HCM inclu...
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#1Barry J. Maron (Tufts Medical Center)H-Index: 178
#2Ethan J. Rowin (Tufts Medical Center)H-Index: 27
Last. Eugene Braunwald (Brigham and Women's Hospital)H-Index: 269
view all 4 authors...
Abstract Hypertrophic cardiomyopathy was first recognized as a disease of obstruction to left ventricular outflow, hence, its early names and acronyms such as idiopathic hypertrophic subaortic obstruction. The nonobstructive subset of patients, incapable of developing mechanical impedance to left ventricular outflow at rest or with physiologic exercise, was initially recognized by the Braunwald group at the National Institutes of Health >50 years ago in the preimaging era, and is now recognized ...
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#1Joon Hwa Hong (Mayo Clinic)H-Index: 3
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Steve R. Ommen (Mayo Clinic)H-Index: 80
view all 7 authors...
Abstract Background Incidence and outcome of mitral valve (MV) surgery are unknown in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy. Objectives This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HOCM. Methods A total of 2,107 septal myectomy operations performed in adults from January 1993 to May 2014 at Mayo Clinic in Rochester, Minnesota, were retrospectively revie...
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#1Fadi J. SawayaH-Index: 17
#2Yves LouvardH-Index: 53
Last. Bertrand CormierH-Index: 31
view all 17 authors...
Abstract Background Although the trans-radial approach (TR) has been applied to various subsets of patients in percutaneous coronary intervention, the feasibility, efficacy, acute procedural and long-term outcomes of TR versus trans-femoral approach (TF) for alcohol septal ablation (ASA) have not yet been determined. Objectives The aim of this study was to compare the short and long-term outcomes of ASA with the TR approach compared to the TF approach. Methods We retrospectively analyzed 240 pat...
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#1Kashish Goel (Mayo Clinic)H-Index: 26
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 103
view all 3 authors...
From the Division of Cardiovascular Diseases, Department of Internal Medicine and Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Jan 28, 2016; revisions receivedMarch 1, 2016; accepted for publication March 5, 2016; available ahead of print April 5, 2016. Address for reprints: Rick A. Nishimura, MD, 200 First St SW, Rochester, MN 55905 (E-mail: rnishimura@ mayo.edu). J Tho...
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Introduction Percutaneous alcohol septal ablation (PTSMA) is an established treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). However, there is concern of a higher risk for ventricular tachyarrhythmias and sudden death due to the myocardial scar created after PTSMA. We investigated the possibility of increased ventricular arrhythmias and risk of sudden death after PTSMA in a subgroup of patients with an already implanted ICD.
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#1Luke K. Kim (NewYork–Presbyterian Hospital)H-Index: 22
#2Rajesh V. Swaminathan (NewYork–Presbyterian Hospital)H-Index: 23
Last. Dmitriy N. Feldman (NewYork–Presbyterian Hospital)H-Index: 31
view all 11 authors...
Importance Previous data on septal myectomy (SM) and alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy have been limited to small, nonrandomized, single-center studies. Use of septal reduction therapy and the effect of institutional experience on procedural outcomes nationally are unknown. Objective To examine in-hospital outcomes after SM and ASA stratified by hospital volume within a large, national inpatient database. Design, Setting, and Participants This study analyze...
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This editorial refers to ‘Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry’[†][1], by J. Veselka et al ., on page 1517. At a recent cardiology meeting in Geneva, one of my former colleagues quoted a remark I had made in the early 1980s during a heart-team meeting on hypertrophic obstructive cardiomyopathy (HOCM) at the University of Lausanne: ‘Wouldn't it be much cheaper and less traumatic for the patient to ...
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#1Josef Veselka (Charles University in Prague)H-Index: 24
#2Morten Kvistholm Jensen (Copenhagen University Hospital)H-Index: 12
Last. Lothar Faber (RUB: Ruhr University Bochum)H-Index: 32
view all 11 authors...
Two thirds of patients with hypertrophic cardiomyopathy (HCM) suffer from a left ventricular obstruction associated with more symptoms and worse prognosis [1] ; [2]. According to American and European Guidelines on HCM, there are two main therapeutic alternatives for treating the left ventricular obstruction: surgical myectomy and alcohol septal ablation (ASA) [1] ; [2]. Both these alternatives are considered safe and effective. However, Panaich et al. have recently demonstrated real world Ameri...
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#1Joonhwa Hong (Mayo Clinic)H-Index: 2
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 103
view all 6 authors...
Abstract Objective Systolic anterior motion of mitral valve (MV) leaflets is a main pathophysiologic feature of left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy. Thus, restricted leaflet motion that occurs with MV stenosis might be expected to minimize outflow tract obstruction related to systolic anterior motion. Methods From January 1993 through February 2015, we performed MV replacement and septal myectomy in 12 patients with mitral stenosis and hyp...
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Cited By58
Newest
#1Daokun Sun (Mayo Clinic)H-Index: 2
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Steve R. Ommen (Mayo Clinic)H-Index: 80
view all 6 authors...
Abstract null null Objective null Some patients with obstructive hypertrophic cardiomyopathy (HCM) may remain limited after surgical relief of the subaortic obstruction. In this report, we describe experience in surgical management of patients with advanced diastolic heart failure symptoms after adequate transaortic septal myectomy for obstructive HCM. null null null Methods null We identified adult patients who presented with heart failure symptoms after previous transaortic septal myectomy for...
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ABSTRACT Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and causes changes in the cardiac muscle affecting ventricular, valvular, and cellular functions. Because HCM is an inherited disorder, all age groups are affected; however, it commonly presents in adolescents, especially athletes. Many patients are asymptomatic and undiagnosed, putting them at risk for sudden cardiac death. This article describes screening and management of patients with HCM.
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#1Shi Chen (Peking Union Medical College)H-Index: 1
#2Liang Chen (Peking Union Medical College)H-Index: 1
Last. Jun Yan (Peking Union Medical College)H-Index: 24
view all 9 authors...
Noonan syndrome (NS) is a genetic syndrome causing obstructive hypertrophic cardiomyopathy (HCM) in infants. Studies of cardiac surgery in pediatric HCM patients with NS (NS-HCM) are lacking. We aim to characterize the early disease course of young NS-HCM patients before adolescence and assess their complications and survival condition after septal myectomy. Pediatric obstructive HCM patients who underwent septal myectomy at age 10 years or under were enrolled consecutively between 2009 and 2019...
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#1Victor Arévalos (University of Barcelona)H-Index: 2
#2Juan José Rodríguez-Arias (University of Barcelona)H-Index: 1
Last. Ander Regueiro (Cardiovascular Institute of the South)H-Index: 22
view all 9 authors...
Hypertrophic cardiomyopathy (HCM) can cause symptoms due to the obstruction of the left ventricle outflow tract (LVOT). Although pharmacological therapy is the first step for treating this condition, many patients do not fully respond to the treatment, and an invasive approach is required to manage symptoms. Septal reduction therapies include septal myectomy (SM) and alcohol septal ablation (ASA). ASA consists of a selective infusion of high-grade alcohol into a septal branch supplying the basal...
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#1Giovanni La CannaH-Index: 40
#2Iside ScarfòH-Index: 4
Last. Ottavio AlfieriH-Index: 94
view all 8 authors...
Background: Myocardial contrast two-dimensional echocardiography (MC-2DE) is widely used to address alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy (HCM). Owing to its limited cut-planes, MC-2DE may inaccurately identify the contrast misplacement associated with an unsuccessful or complicated ASA outcome. Objective: The aim of this study was to assess the added value of myocardial contrast three-dimensional echocardiography (MC-3DE) compared with MC-2DE to identify the a...
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#1Ali J. Marian (University of Texas at Austin)H-Index: 64
Hypertrophic cardiomyopathy (HCM) is a genetic disease of the myocardium characterized by a hypertrophic left ventricle with a preserved or increased ejection fraction. Cardiac hypertrophy is often asymmetrical, which is associated with left ventricular outflow tract obstruction. Myocyte hypertrophy, disarray, and myocardial fibrosis constitute the histological features of HCM. HCM is a relatively benign disease but an important cause of sudden cardiac death in the young and heart failure in the...
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#1Hao Cui (Mayo Clinic)H-Index: 7
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 132
Last. Joseph J. Maleszewski (Mayo Clinic)H-Index: 42
view all 12 authors...
Abstract Background Hypertrophic cardiomyopathy (HCM) is characterized by multiple pathological features including myocyte hypertrophy, myocyte disarray, and interstitial fibrosis. Objectives This study sought to correlate myocardial histopathology with clinical characteristics of patients with obstructive HCM and post-operative outcomes following septal myectomy. Methods The authors reviewed the pathological findings of the myocardial specimens from 1,836 patients with obstructive HCM who under...
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Background Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of sudden death in young people and is associated with an elevated risk of mood disorders. Depression has emerged as a critical risk factor for development and progression of coronary artery disease; however, the association between depression and HCM outcomes is less clear. We sought to examine the impact of depression on clinical outcomes in patients with HCM. Methods and Results Between January 2014 and Dec...
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#1Yuri OchiH-Index: 5
#2Toru KuboH-Index: 26
Last. Hiroaki KitaokaH-Index: 26
view all 7 authors...
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#1Rohit K. Kharbanda (EUR: Erasmus University Rotterdam)H-Index: 2
#2Lucas Lodder (EUR: Erasmus University Rotterdam)
Last. Ad J.J.C. Bogers (EUR: Erasmus University Rotterdam)H-Index: 76
view all 9 authors...
Aims: The aims of this study are to investigate the incidence and determinants of post-operative atrial arrhythmias, conduction disorders and mortality in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing transaortic myectomy. Methods and results: This retrospective single-center study was conducted in 249 patients (median age 54 years [40–64], 42% female) undergoing transaortic myectomy. Post-operative atrial fibrillation (AF) was reported in 84 patients (33.7%), including 56 p...
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