Analysis And Study Of Surgical Prognosis Of Hypertrophic Cardiomyopathy Complicated With Middle Left Ventricular Obstruction And Left Ventricular Apical Aneurysm

Aims:We investigated the early and late surgical outcome of hypertrophic cardiomyopathy(HCM)patients with midventricular obstruction(MVO)and the potential risk factors of long-term major adverse cardiac or cerebrovascular events(MACCE).Methods and results:This is a single-center retrospective study assessing surgical outcome of 67 consecutive symptomatic HCM patients with MVO.The results are further compared in two subgroups based on the presence or absence of the left ventricular apical aneurysm(LVAA):Group M(MVO without LVAA,n=56)and Group MA(MVO with LVAA,n=11).The follow-up duration was 4.0±2.3years(1.0-9.3 years).No patients were lost to follow-up.The resting gradient of left ventricle outflow tract(LVOT)and MVO decreased significantly at the most recent evaluation(P<0.001).Overall,92.5%of the patients reported improvement in symptoms and New York Heart Association(NYHA)class at follow-up(P<0.001).A total of 2(3.0%)patients died with 1 death in each group.The estimated survival rates for cardiovascular related mortality at 1,4 and 7 years were 98.5%,98.5%,90.3%respectively.During the follow up period,6(9.0%)patients developed at least 1 major adverse cardiac or cerebrovascular events(MACCE).Cumulative incidence of MACCE for patients at Group MA were significantly higher than Group M(P=0.015).In a cox multivariable analysis,the presence of LVAA was an independent risk factor of long-term MACCE in patients with MVO after surgery(HR,7.471;95%CI,1.484-37.626;P=0.015).Conclusion:Surgical treatment for HCM patients with MVO is associated with favorable early and late outcomes.The presence of LVAA was an independent risk factor of postoperative long-term MACCE in HCM patients with MVO.Objective:To evaluate the efficacy of surgical treatment after percutaneous transluminal septal myocardial ablation(PTSMA)in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:We retrospectively examined 27 consecutive patients with HOCM operated in our institution from 2002-12 to 2015-9。All patients underwent PTSMA before surgery.Male 17(63.0%)、age 491±8(32-62)years.All patients had drug-refractory symptoms even after PTSMA and with a left ventricular outflow tract(LVOT)gradient of 98±30mmHg(50-159mmHg).Documentation of preoperative patient status,echocardiography and electrocardiogram data,operative record and New York Heart Association(NYHA)class were included in clinical assessment.The latest follow-up assessment was obtained through clinic visits and telephone interview.Results:Of all the patients,17 patients(63.0%)underwent isolated septal myectomy and contaminated procedures like coronary artery bypass grafting and atrial fibrillation ablation were carried out in other patients.The mean follow-up time was 19(13-38)month with a 92.6%follow-up rate.The LVOT obstruction was improved in most patients,21(77.7%)patients were free of symptoms,92.6%of the patients were in New York Heart Association functional class I.Complete atrioventricular block occurred in 2 patients.One patient died before discharge and no deaths occurred in follow up period,the mortality rate was 3.7%overall.The cumulative survival rate at 1 and 3 years was 96.3%and 96.3%respectively.Conclusions:Surgical treatment in patients with HOCM after PTSMA can relief symptoms and improve cardiac functional class.The mortality and mobility related to the operation is acceptable.