Abstract 13210: Concomitant Septal Myectomy Can Improve Left Ventricular and Atrial Function Detected by 2d Speckle Echocardiography as Well as Long term Survival In Patients Undergoing Aortic Valve Replacement With Marked Ventricular Hypertrophy
Introduction: Patients requiring aortic valve replacement (AVR) frequently have left ventricular hypertrophy (LVH) /sigmoid septum, which causes persistent outflow obstruction (LVOTO) postoperatively. Surgical AVR enables such patients to undergo concomitant septal myomectomy. However, the effect on their postoperative myocardial function and long-term outcome is yet to be elucidated.
Hypothesis: Concomitant myectomy may be beneficial for selected patients undergoing surgical AVR and possible LVOTO.
Methods: Postoperative outcome and myocardial functional changes before and after surgery were assessed by conventional and 2D speckle tracking echocardiography in patients undergoing AVR and myectomy (Group M, n=16, male 21%, mean age 76.0 years) The results were compared with age/sex-matched controls who had marked LVH/LVOTO undergoing AVR alone (Group C, n=27). The relation between preoperative echo-derived local myocardial function and histology of resected myocardium in Group M was also investigated.
Results: Preoperative echo parameters were not different between the groups. However, a decrease in LV E/E’ and an increase in the absolute value of basal septum longitudinal strain were seen postoperatively only in Group M (17.3±4.3 to 15.2±2.6, p=0.013, -9.3±4.5 to -12.8±3.8%, p=0.008, respectively). Peak LA strain values increased in both groups, but the improvement was more apparent in Group M (Group M; 20.6±5.3 to 28.3±7.1%, p=0.008, Group C; 21.9±5.9 to 26.9±6.0%, p=0.046,). Survival following surgery was better in Group M than Group C (30 days, 1 and 5 year, 100.0% vs 88.2%, 100.0% vs 75.6%, 100.0% vs 68.8%, respectively, p=0.028). Histology of resected myocardium in Group M showed remarkable fibrosis (mean 6.8%, range 1-17%) and thickness of endocardium (mean 1031μm, range 287-2505μm), and the degree of fibrotic area was significantly correlated with preoperative basal septum strain value (r2=0.6, p=0.041).
Conclusions: Concomitant septal myectomy with AVR improves postoperative LV diastolic function, as well as LA function. Furthermore, it improved short and long-term survival as compared to those undergoing AVR alone. AVR with myectomy may be a beneficial option for patients with marked LVH /sigmoid septum-related LVOTO.
Author Disclosures: K. Kuroda: None. T.S. Kato: None. K. Kuwaki: None. K. Uto: None. S. Yoshizawa: None. T. Nishikawa: None. A. Amano: None.
- © 2015 by American Heart Association, Inc.