| Objective:This study was aimed to report the experiences of surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM) in Fuwai hospital. We tried to detect the association between preoperative NT-proBNP levels and postoperative clinical prognosis, and the influences of concomitant mitral valve procedure on clinical outcomes.Methods:We retrospectively reviewed all of the 640 consecutive HOCM patients who underwent the Morrow procedure at the institution from October 1996 to December 2014. Follow-up was conducted by telephone questionnaire.Results:Nine (1.4%) patients died perioperatively. Iatrogenic ventricular septal defects were identified in nine (1.4%) patients by the intraoperative transesophageal echocardiography.16 (2.6%) were diagnosed with complete atrial ventricular block. The hemodynamic improvement was confirmed among all patients immediately postoperation. The left ventricular outflow tract peak gradient decreased from 88.4±30.3 mmHg preoperatively to 16.8±12.9 mmHg postoperatively (p<0.001). The mitral regurgitations were less than medium in 625 patients. The one-year, three-year and five-year overall survival rates were 98.3%,95.6% and 90.4%. The one-year, three-year and five-year survival rates free from composite endpoint events were 94.0%,84.5% and 74.4%. Patients with concomitant mitral valve replacement were matched with patients without concomitant mitral valve procedure using propensity score match. There were no differences between the two groups about one-year, three-year and five-year overall survival rates (p=0.793) and survival rates free from composite endpoint events (p=0.259). Patients with concomitant mitral valvuloplasty were matched with patients without concomitant mitral valve procedure using propensity score match. The differences of one-year, three-year and five-year overall survival rates and survival rates free from composite endpoint events between the two groups were still not statistically significant (p=0.674, p=0.988 respectively). Experienced surgeons dredged the left ventricular outflow tract much more effectively with lower systolic peak gradient compared to the novices (14.2±7.9 mmHg vs 20.9±17.2 mmHg, p<0.001). The level of serum NT-proBNP did not decrease significantly postoperation (1307.0±1151.2pg/ml vs 971.5± 656. lpg/ml, p=0.108). A multivariable Cox proportional hazard model detected that iatrogenic ventricular septum defects and atrial fibrillation were independent predictors of worse outcomes in HOCM patients undergoing Morrow procedure.Conclusions:An extended Morrow procedure is an effective and safe therapy for HOCM. But we confirmed that there was a learning curve of this procedure for a cardiac surgeon. Concomitant mitral valve procedure did not improve clinical outcomes of extended Morrow procedure. Preoperative NT-proBNP was not associated with postoperative clinical prognosis. Atrial fibrillation was an independent predictor of worse outcomes. Objective:An extended Morrow procedure is an effective and safe treatment for hypertrophic obstructive cardiomyopathy (HOCM).The necessity of a concomitant mitral valve (MV) procedure remains controversial. We aimed to study the outcomes of an extended Morrow procedure without a concomitant MV procedure for HOCM patients without intrinsic abnormalities of the valve apparatus.Methods:We retrospectively reviewed all of the 232 consecutive HOCM patients who underwent extended Morrow procedures at Fuwai institution performed by one experienced surgeon from January 2010 to October 2014. Results:Only 10 patients with intrinsic MV diseases underwent concomitant MV procedures, while three of them underwent mitral valvuloplasty and seven underwent mitral valve replacement. No perioperative death was observed. Of the 232 patients,230 patients had no to mild mitral regurgitation (MR) postoperatively. We separated the 232 patients into two groups. One group included patients with mild MR and the other included patients with moderate or severe MR preoperatively. The three-month, one-year, and three-year composite endpoint event-free survival rates were 99%,99%,89.6%, and 100%,98.5%, and 88%, respectively for the two groups (Taron-Ware test, p=0.820). After adjusted for left atrial dimension, LVOT gradient, history of PTSMA, there was still no difference in composite end point event-free survival rates between the two groups (p=0.487). When we separated the patients into two groups according to no or trace MR and mild MR postoperatively, there was also no significant difference in the three-month, one-year, and three-year composite end point event-free survival rates (100%,98.9%,88.0% and 99.3%,98.6%, 89.2%, respectively for the two groups, p=0.830).Conclusion:Concomitant mitral valve procedures are not necessary for HOCM patients with MR, even moderate to severe, that is caused by SAM. Residual mild MR postoperatively did not influence the surgical outcomes. Old age, iatrogenic ventricular septal defect,and postoperative atrial fibrillation are independent predictors of worse outcomes.Objective:Hypertrophic cardiomyopathy (HCM) with mid ventricular obstruction is less common than subaortic obstruction. Gaining access to and exposing the mid portion of left ventricular through the aortic valve is difficult. Transapical incision to expose the mid ventricular is adopted by most surgeons. And HOCM patients with interventricular septum thickness less than 18mm suffered more complications when treated by surgery. So we aimed to study the outcome of HOCM patients with mid ventricular obstruction underwent extended Morrow procedure, and the safety of surgical treatment when interventricular septum thickness less than 18mm.Methods:We included 32 HOCM patients with mid ventricular obstruction and 86 HOCM patients with interventricular septum thickness less than 18mm. Propensity score match was used to match these two groups of patients with other HOCM patient underwent surgery in Fuwai hospital.Results:There was no perioperative death among the 32 patients with mid ventricular obstruction. One (1.3%) patient suffered iatrogenic ventricular septum defect. And one patient was diagnosed with complete atrial ventricular block maybe due to concomitant reduction of right ventricular outflow tract. Systolic peak gradient located at mid ventricular decreased from 55.7±22.2 mmHg preoperatively to 21.0±21.8 mmHg postoperatively (p<0.001). The three-month, one-year, and three-year overall survival rates were 100%,100% and 100%, which were not significantly different from that of the matched patients (also 100%, 100% and 100%, log-rank test, p=0.486).Differences in three-month, one-year, and three-year composite endpoint events free survival rates between the two groups were also not significantly (log-rank test, p=0.154). For the 86 patients with interventricular septum thickness less than 18mm, there was only one (1.2%) perioperative death because of the iatrogenic ventricular septum defect. This patient had a history of PTSMA. The left ventricular outflow tract peak gradient decreased to 16.5±12.2 mmHg postoperatively (compare to 90.8±31.2 mmHg preoperatively, p<0.001). There were four (4.6%) patients with residual gradient after operation and one (1.2%) patient with SAM.Conclusion:For the patients with mid ventricular obstruction, extended Morrow procedure,when extending the myectomy towards apex beyond the base of anterior papillary muscle, was effective in relieving mid ventricular obstruction. For patients with interventricular septum thickness less than 18mm, extended Morrow procedure was effective and safe.
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