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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 666-674, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
R Mohr, HV Schaff, GK Danielson, FJ Puga, JR Pluth and AJ Tajik
From 1972 through 1987, 115 patients between the ages of 1 and 83 years
(mean, 44.5 years) underwent operation for hypertrophic obstructive
cardiomyopathy. Methods of relief of left ventricular outflow obstruction
were septal myectomy/myotomy (n = 109), mitral valve replacement (n = 4),
and myectomy/myotomy plus mitral valve replacement (n = 2); concomitant
procedures included coronary artery bypass (n = 19) and aortic valve
replacement (n = 9). Systolic gradient (peak-to- peak) from the left
ventricle to the aorta decreased from 70 +/- 38 mm Hg (mean +/- standard
deviation) to 9 +/- 11 mm Hg. There were six hospital deaths, for an
overall operative risk of 5.2%; one death occurred among 83 patients less
than age 65 years (operative risk, 1.2%), and five deaths occurred in 32
older patients (operative risk, 15.6%; p = 0.008 for difference between age
groups). Four (22.2%) of 18 patients with a residual gradient greater than
15 mm Hg died, compared with two (2.1%) of 97 patients with a lower
gradient (p = 0.003). Follow-up ranged from 0.5 to 16 years (mean, 5.1
years), and 5-year actuarial survival rate, including hospital deaths, was
84% +/- 4%. The 5-year survival rate was decreased in patients who had
operative procedures other than myectomy/myotomy (69% versus 91%, p less
than 0.005) and in patients aged 65 years or older (54% versus 93%, p less
than 0.005). No correlation was found between preoperative symptoms,
functional class, left ventricle-aorta pressure gradient, or mitral valve
insufficiency and operative or late mortality. Preoperative symptoms were
relieved in 57 (76%) of 75 patients with dyspnea, 49 (83%) of 59 patients
with angina, and 22 (96%) of 23 patients with syncope. This experience
confirms the effectiveness of operation for relief of symptoms in patients
with the obstructive form of hypertrophic cardiomyopathy. The current
operative mortality rate is low, especially in patients less than 65 years
of age (1.2%). Our experience suggests that incomplete relief of left
ventricular outflow obstruction may increase the risk of early
postoperative death.
ARTICLES
The outcome of surgical treatment of hypertrophic obstructive cardiomyopathy. Experience over 15 years
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905.
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