Surgical Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy (HOCM)—A Single Center Experience with Postoperative and Long-Term Follow-Up

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All articles of this category (opens in new window) Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a complex cardiac condition characterized by dynamic left ventricular outflow tract (LVOT) obstruction and often co-existing abnormalities of the mitral valve (MV), that may alter the surgical methods used. This study aims to investigate postoperative and long-term follow-up of patients undergoing surgical treatment at our institution. Methods: From 2012 to 2023, a total of 54 patients were retrospectively analyzed. Baseline characteristics, echocardiographic parameters and perioperative outcome were analyzed, respectively. Mean time follow-up was 45.2 ± 39.8 months. Long-term freedom from reoperation was analyzed with Kaplan–Meier analysis. Results: Median age was 57 years (IQR 27–80) and females presented 50% of the cohort. The majority of patients were highly symptomatic (NYHA classes III–IV, 63%) and presented severe mitral valve (MV) regurgitation (MR ≥ III, 66.7%). Preoperative echocardiography documented a mean LVOT gradient at rest of 84.2 ± 62.8 mmHg with interventricular septal thickness in diastole (IVSd) of 22.3 ± 5.2 mm. Isolated myectomy (Morrow procedure) was performed on 19 patients (35.2%), additional MV repair was performed on 18 patients (33%) and MV replacement on 12 patients (22.2%). Postoperative echocardiography demonstrated a significant reduction of LVOT gradient at rest from (84.2 ± 62.8 to 17.1 ± 13.9 mmHg, p < 0.001) at discharge. 7 patients (12.9%) required permanent pacemaker implantation. In-hospital mortality rate comprised 1 patient (1.9%) due to multiple stroke syndrome and 4 patients (7.4%) underwent reoperation within 1 week after surgery (1 re-myectomy, 3 mechanical mitral valve replacement). Long-term follow-up showed a significant improvement in NYHA class ( p < 0.001) with 87.1% patients describing NYHA class ≤II. In 81.1% of patients MV regurgitation ≤II occurred. Freedom from reoperation was 90% at mean follow-up time. One patient (1.9%) received mechanical MV replacement 4 years after initial repair. HOCM-related mortality at mean follow-up time was 0% after one initial perioperative death. Conclusion: Our single-center experience suggests that surgical treatment in patients with HOCM results in substantial enhancements in long-term symptom relief, along with notable reduction in LVOT obstruction. Mortality was very low and freedom from reoperation was 90% at a mean follow-up time of 45.2 months, leading to favorable long-term survival. Publication History Article published online: 13 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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