Abstract 14759: Aortic Valve Surgery With and Without Concomitant Septal Myectomy - A Propensity Score Matched Comparison
Introduction: Concomitant subvalvular septal myectomy during aortic valve replacement (AVR) is an effective surgical technique for septal reduction therapy. Higher rates of complications (e.g. pacemaker implantation) have been reported, however, comparative studies adjusting for important confounders are lacking. This study investigates outcome and complications associated with concomitant myectomy in a large cohort using propensity score matching.
Patients: A total of 2199 consecutive patients receiving isolated AVR (N=1987) or AVR + concomitant myectomy (N=212) were included (2009-2015). The majority of patients suffered from relevant aortic valve stenosis. For comparison patients with previous cardiac procedures, emergency surgery, concomitant cardiac procedures and endocarditis were excluded.
Methods: Comparison was performed first by examining characteristics and outcome of the overall cohort as reference to previously reported data. In a second step propensity score matching was performed with concomitant myectomy as the dependent feature.
Results: Unmatched patients with isolated AVR were younger (68 vs 71 years,P< 0.001), more often male (63% vs. 32%,P< 0.001) and received in average larger prosthetic valves (23.5 vs. 22.4 mm,P< 0.001) compared to patients with concomitant myectomy. After propensity adjustment (total N=374) no significant differences in baseline characteristics regarding the matching variables were evident. Hospital mortality (1.6% vs. 2.1%,P=1.000) and long-term survival (84.4±4.8% vs. 86.1±4.9% at 6 years,P=0.957) were comparable and no significant difference in pacemaker-implantation rate was observed (3.7% vs. 5.3%,P=0.621). The overall patient cohort had a long-term survival equivalent to an age and sex matched normal population (P=0.178).
Conclusions: This matched comparison study reveals that concomitant myectomy in patients undergoing surgery for AVR is a safe procedure resulting in comparable hospital mortality and long-term survival. Concomitant subvalvular myectomy seems not to increase pacemaker implantation rate. Patients after isolated AVR with and without myectomy enjoy a long-term survival equivalent to their age and sex matched normal population.
Author Disclosures: K. von Aspern: None. C.D. Etz: None. J. Haunschild: None. C. Dahlenburg: None. G. Hirnle: None. S. Lehmann: None. J. Garbade: None. F. Bakhtiary: None. M. Misfeld: None. F.W. Mohr: None.
- © 2016 by American Heart Association, Inc.