title: Long-term clinical and echocardiographic outcomes of extensive septal myectomy for hypertrophic obstructive cardiomyopathy in Chinese patients.
abstract: BACKGROUND
  There has been limited data addressing outcomes of extensive septal myectomy in Chinese patients with hypertrophic obstructive cardiomyopathy (HOCM). In this study, the objective was to evaluate the clinical and echocardiographic outcomes of extensive septal myectomy in a relative large number of Chinese HOCM patients over long-term follow-up.
  
  
  METHODS
  We retrospectively studied 139 consecutive HOCM patients (age 43 ± 15 years, 37 % male) who underwent extensive left ventricular septal myectomy. During the perioperative period, all patients were examined by echocardiography. All-cause death and cardiac death were considered as primary endpoints during follow-up. Perioperative data was obtained by retrospective review of institutional surgical databases. Follow-up data of echocardiography and clinical status was recorded through outpatient interview.
  
  
  RESULTS
  Perioperative events consisted of arrhythmia, retraction injury to aortic valve leaflets, pleural effusion, and hemodialysis and the use of intra-aortic balloon pump. There was no in-hospital mortality. The follow-up period averaged 5.6 ± 0.9 years and overall survivals were 100.0, 99.3, 99.3, 98.5 and 97.8 % at 1, 2, 3, 4 and 5 years, respectively. Left ventricular outflow tract (LVOT) gradient decreased form preoperative 84 ± 17 mmHg to 12 ± 3 mmHg at 2.5 years after surgery and it further reduced to 6 ± 3 mmHg at 5 years after surgery (P < 0.05). Compared with the preoperative levels, interventricualr septal thickness decreased by 32 % while diastole left ventricular inner diameter approximately increased by 10 % and ejection fraction (EF) was significantly elevated during follow-up (P < 0.05). By echocardiography detection, mitral regurgitation was ameliorated for HOCM patients after surgery. There was significant improvement in New York Heart Association (NYHA) class. The proportion of NYHA III and IV decreased from preoperative 58 to 19 % at 2.5 years after surgery and it reduced to 11 % at 5 years after operation.
  
  
  CONCLUSIONS
  Extensive septal myectomy offers minimal operative risk and provides long-term relief for LVOT obstruction in Chinese HOCM patients.
authors.affiliation: Second Division of Ultrasound Diagnosis, Cangzhou Central Hospital, 16 Xin-Hua-West Street, Cangzhou, Hebei, 061001, People's Republic of China. yaolei_pubmed@sina.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Yao
authors.affiliation: Second Division of Ultrasound Diagnosis, Cangzhou Central Hospital, 16 Xin-Hua-West Street, Cangzhou, Hebei, 061001, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Cardiothoracic Surgical Department, Shandong Chinese Medical Hospital, Jinan, 250011, China.
authors.forename: Xiong-Jun
authors.initials: XJ
authors.lastname: Lu
authors.affiliation: Second Division of Ultrasound Diagnosis, Cangzhou Central Hospital, 16 Xin-Hua-West Street, Cangzhou, Hebei, 061001, People's Republic of China.
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Miao
authors.affiliation: Second Division of Ultrasound Diagnosis, Cangzhou Central Hospital, 16 Xin-Hua-West Street, Cangzhou, Hebei, 061001, People's Republic of China.
authors.forename: Xiao-Ning
authors.initials: XN
authors.lastname: Kang
authors.affiliation: Ultrasonic Imaging Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China.
authors.forename: Fu-Jian
authors.initials: FJ
authors.lastname: Duan
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extensive septal myectomy; Hypertrophic cardiomyopathy; Hypertrophic obstructive cardiomyopathy