Septal myotomy-myomectomy versus mitral valve replacement in hypertrophic cardiomyopathy. Ten-year follow-up in 185 patients.
Between 1963 and 1985, 185 patients with hypertrophic cardiomyopathy (HCM) were treated with septal myotomy-myomectomy (MM) or mitral valve replacement (MVR) at our institution; 127 of these underwent septal MM, and 58 underwent MVR alone. The 1-month mortality was 4.7% for the septal MM group and 6.9% for the MVR group (p = NS). The mean time of postoperative follow-up was 118 months, ranging between 1 and 196 months. The annual mortality was 0.7% for the septal MM group and 1.3% for the MVR group (p = NS). In the MVR group, 98% of patients had been assigned to New York Heart Association (NYHA) functional classes III and IV before surgery; only 24% were classified as such at 10-year follow-up (p less than 0.001). In the septal MM group, 90% were in NYHA functional classes III and IV before surgery whereas only 27% were in these two classes postoperatively (p less than 0.001). A comparison of preoperative and postoperative hemodynamic findings revealed a significant reduction in left ventricular outflow gradient at rest: from 69 +/- 41 mm Hg preoperatively to 10 +/- 22 mm Hg postoperatively (p less than 0.001) in the septal MM group and from 75 +/- 45 mm Hg preoperatively to 10 +/- 21 mm Hg postoperatively (p less than 0.001) in the MVR group. In addition, the MVR group had a significant postoperative reduction in mean left ventricular end-diastolic pressure, from 21 mm Hg preoperatively to 15 mm Hg postoperatively (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Division of Cardiology, Texas Heart Institute, Houston.
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Krajcer
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Leachman
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Cooley
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Coronado
D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006346:Heart Septum / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications / Q000453:epidemiology