Comparison Of Clinical Efficacy Of Two Different Surgical Methods For Hypertrophic Obstructive Cardiomyopathy

Objective: We analyze and compare the efficacy and follow-up results of two different surgical methods(left ventricular outflow tract evacuation,left ventricular outflow tract evacuation and mitral valve replacement)in our department in the treatment of hypertrophic obstructive cardiomyopathy(HOCM)to provide the basis for surgical selection of hypertrophic obstructive cardiomyopathy.Data and methods: We retrieved from December 2007 to December 2017 in the Department of Cardiology,Union Hospital,Fujian Medical University,and a total of 51 patients were treated with HOCM using two different surgical methods(left ventricular outflow tract dredging and left ventricular outflow tract dredging + mitral valve replacement(MVR)).Of the 51 patients,35(68.6%)were males and 16(31.4%)were females.The age was 47.9 ± 13.4 years and the weight was 60.4 ± 8.6 kg.The preoperative main clinical symptoms included chest congestion in 49 cases(96.1%),chest pain in 9 cases(17.6%),palpitation in 9 cases(17.6%),and syncope in 1 case(2.0%).Among all patients,there were 5 patients(9.8%)with preoperative NYHA class II,37 patients(72.5%)with NYHA class III,and 9 patients(17.6%)with NYHA class IV;There was SAM in 38 patients(74.5%),and 47 cases(92.2%)had different degrees of mitral regurgitation.Fifty-one patients with HOCM underwent two different surgical methods.31 cases(60.8%)underwent left ventricular outflow tract dredging,20 cases underwent left ventricular outflow tract dredging and MVR(39.2%);The echocardiograms were reviewed before operation and 1 week after operation and 3 months after operation and 6 months after operation.The data were grouped according to different surgical procedures.The t-test method was used to compare the mean of the samples.Results: One patient who underwent left ventricular outflow tract dredging + MVR suddenly developed ventricular fibrillation 2 days after surgery.The family members of the patient gave up after the rescue.In the remaining 50 patients,echocardiography at 1 week postoperatively revealed that left ventricular outflow tract pressure was significantly lower than before the surgery.Among them,the left ventricular outflow tract pressure difference was reduced by 52.52±20.143 mmHg in 31 patients who underwent left ventricular outflow tract dredging alone.Left ventricular outflow tract clearing + MVR was performed in 19 patients left.The left ventricular outflow tract differential pressure was reduced by 56.00±21.113 mmHg in 19 patients with left ventricular outflow tract dredging and MVR..P=0.520(P>0.05)was statistically significant between the two groups.Echocardiography at 3 months postoperatively indicated that the left ventricular outflow tract had significant pressure decrease than the preoperative.There was also a significant decrease in the left ventricular outflow tract pressure difference of 57.10±20.370 mmHg in 31 patients with simple left ventricular outflow tract dredging,and left ventricular outflow tract pressure difference in 19 patients with left ventricular outflow tract dredging + MVR with the reduction of 56.00±21.113 mmHg.There was no statistical difference between the two groups(P=0.856,P>0.05).Echocardiography at 6 months postoperatively indicated that the left ventricular outflow tract pressure difference was significantly lower than before surgery.31 cases of simple left ventricular outflow dreding the left ventricular outflow tract pressure difference was reduced by 56.97±20.223 mmHg.The left ventricular outflow tract pressure difference was reduced by 56.26±21.005 mmHg in 19 patients with left ventricular outflow tract dredging and MVR.P=0.907(P>0.05)is not statistically significant.Patients undergoing left ventricular outflow tract evacuation + mitral valve replacement had mitral regurgitation eliminated due to replacement of the mitral valve.Patients undergoing left ventricular outflow tract dredging were reviewed 1 week,3 months,and 6 months after surgery and echocardiography revealed a significant improvement in mitral regurgitation and SAM.Conclusions: Reviewing echocardiography at 1 week,3 months,and 6 months after operation suggested that the two surgical methods for HOCM treatment could significantly reduce postoperative left ventricular outflow tract pressure difference compared with preoperative ones,and the postoperative left ventricular outflow tract pressure drop of the two groups is about the same.The combined mitral regurgitation will be significantly reduced.