Abstract 3058: Surgery for Hypertrophic Cardiomyopathy in Times of Alcohol Septal Ablation
Objective: Since the introduction of Alcohol Septal Ablation (ASA) into the therapy of hypertrophic cardiomyopathy (HCM) a significant shift in the spectrum and extent of the disease in patients (pts) refered to surgery has been observed. It is the intention of this study to report the indications for surgery and the mid-term results.
Methods: We report the short- and mid-term results of a consecutive series of 139 (age at operation 55+-14 (range 11–77) years, 60% male) pts who underwent septal myectomy and additional procedures at our institution between 2001 and 2005. We compared the extent of the HCM, valvular involvement, subaortic and septal fibrosis, ventricular and atrial arrhythmias, CAD and the type of surgical intervention and concomitant procedures.
Results: Indications were asymmetric septum hypertrophy (ASH) in 92%, failed ASA in 10%, restenosis after myectomy in 2%, fibrotic stenosis of the left ventricular outflow tract in 15%, ASH plus mitral regurgitation in 11%, ASH plus aberrant papillary muscle in 8%, biventricular or midventricular stenosis in 8%, ASH plus CAD in 16% and ASH plus aortic valve disease in 7%. Procedures included septal myectomy in 92%, mitral valve repair or replacement in 15%, aortic valve replacement in 7%, right- or midventricular myectomies in 8%, CABG in 31% (43 pts), ICD implantation in 28% and atrial ablation in 2%. Other procedures were performed in 8%. 1 pt (0.8%) died early, 3 (2.4%) in the follow-up period. Postoperative morbidity included VSD in 1 pt and AV-block III in 3. After a mean follow-up of 39 months 82% of pts are in NYHA classes I or II.
Conclusions: Pts referred to surgery since the advent of ASA have more complex cardiac disease than reported in the literature, often including ASH with fibrotic elements, mitral- or aortic valve involvement or atypical HCM. Furthermore concomitant cardiac pathologies like CAD, arrhythmias and congenital disease are present in a large portion of pts. Isolated septal myectomy was performed in only 31% of pts, most of them not suited for ASA because of the anatomy of the septal perforators. Nonetheless, the overall results compare favourable with reported series. This underscores the important role that surgery plays today in the treatment of HCM especially in pts not amenable to ASA.