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Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)

Introduction and objectives: Septal myectomy remains the first septal reduction therapy for hypertrophic obstructive cardiomyopathy in young patients and those requiring concomitant procedures. Its role in advanced ages is questioned due to perceived increased risk. We assess the outcomes of surgica...

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Autores principales: Pruna-Guillen, Robert, Pereda, Daniel, Castellà, Manuel, Sandoval, Elena, Affronti, Alessandro, García-Álvarez, Ana, Perdomo, Juan, Ibáñez, Cristina, Jordà, Paloma, Prat-González, Susanna, Alcocer, Jorge, Barriuso, Clemente, Llopis, Jaume, Quintana, Eduard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397149/
https://www.ncbi.nlm.nih.gov/pubmed/34441795
http://dx.doi.org/10.3390/jcm10163499
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author Pruna-Guillen, Robert
Pereda, Daniel
Castellà, Manuel
Sandoval, Elena
Affronti, Alessandro
García-Álvarez, Ana
Perdomo, Juan
Ibáñez, Cristina
Jordà, Paloma
Prat-González, Susanna
Alcocer, Jorge
Barriuso, Clemente
Llopis, Jaume
Quintana, Eduard
author_facet Pruna-Guillen, Robert
Pereda, Daniel
Castellà, Manuel
Sandoval, Elena
Affronti, Alessandro
García-Álvarez, Ana
Perdomo, Juan
Ibáñez, Cristina
Jordà, Paloma
Prat-González, Susanna
Alcocer, Jorge
Barriuso, Clemente
Llopis, Jaume
Quintana, Eduard
author_sort Pruna-Guillen, Robert
collection PubMed
description Introduction and objectives: Septal myectomy remains the first septal reduction therapy for hypertrophic obstructive cardiomyopathy in young patients and those requiring concomitant procedures. Its role in advanced ages is questioned due to perceived increased risk. We assess the outcomes of surgical relief of obstruction in patients beyond 65 years old. Methods: A single-center retrospective review of patients ≥ 65 years old undergoing septal myectomy through median sternotomy between April 2015 and February 2020. Results: We identified 52 patients. Mean age was 71.8 ± 4.9 years; 36 (69.2%) were females. All were symptomatic. Mean highest LVOT gradient was 90 ± 39 mmHg. All patients had systolic anterior motion (SAM) of the mitral valve and 36 (69.2%) ≥ moderate mitral regurgitation. Additional LVOT interventions beyond myectomy were performed in 34 (65.4%). At least one other cardiac concomitant procedure was performed 44 (84.6%). No perioperative mortality in elective surgery occurred. One patient (1.9%) developed atrio-ventricular block. Postoperative mean gradient was 4.3 ± 1.9 mmHg, with 46 (88.4%) achieving complete resolution of obstruction. Mitral regurgitation was reduced to grade ≤ I in 46 (88.5%). Mean follow-up time was 2.3 ± 1.2 years and 82% of patients were in NYHA I. Survival at 2 years was 98%. Conclusion: Septal myectomy in the elderly is a safe and effective operation despite the need for concomitant procedures. LVOT interventions beyond septal myectomy to relieve obstruction are common in this advanced cohort of hypertrophic cardiomyopathy patients. This operation carried at experienced centers seems an unmatched therapeutic option.
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spelling pubmed-83971492021-08-28 Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†) Pruna-Guillen, Robert Pereda, Daniel Castellà, Manuel Sandoval, Elena Affronti, Alessandro García-Álvarez, Ana Perdomo, Juan Ibáñez, Cristina Jordà, Paloma Prat-González, Susanna Alcocer, Jorge Barriuso, Clemente Llopis, Jaume Quintana, Eduard J Clin Med Article Introduction and objectives: Septal myectomy remains the first septal reduction therapy for hypertrophic obstructive cardiomyopathy in young patients and those requiring concomitant procedures. Its role in advanced ages is questioned due to perceived increased risk. We assess the outcomes of surgical relief of obstruction in patients beyond 65 years old. Methods: A single-center retrospective review of patients ≥ 65 years old undergoing septal myectomy through median sternotomy between April 2015 and February 2020. Results: We identified 52 patients. Mean age was 71.8 ± 4.9 years; 36 (69.2%) were females. All were symptomatic. Mean highest LVOT gradient was 90 ± 39 mmHg. All patients had systolic anterior motion (SAM) of the mitral valve and 36 (69.2%) ≥ moderate mitral regurgitation. Additional LVOT interventions beyond myectomy were performed in 34 (65.4%). At least one other cardiac concomitant procedure was performed 44 (84.6%). No perioperative mortality in elective surgery occurred. One patient (1.9%) developed atrio-ventricular block. Postoperative mean gradient was 4.3 ± 1.9 mmHg, with 46 (88.4%) achieving complete resolution of obstruction. Mitral regurgitation was reduced to grade ≤ I in 46 (88.5%). Mean follow-up time was 2.3 ± 1.2 years and 82% of patients were in NYHA I. Survival at 2 years was 98%. Conclusion: Septal myectomy in the elderly is a safe and effective operation despite the need for concomitant procedures. LVOT interventions beyond septal myectomy to relieve obstruction are common in this advanced cohort of hypertrophic cardiomyopathy patients. This operation carried at experienced centers seems an unmatched therapeutic option. MDPI 2021-08-08 /pmc/articles/PMC8397149/ /pubmed/34441795 http://dx.doi.org/10.3390/jcm10163499 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pruna-Guillen, Robert
Pereda, Daniel
Castellà, Manuel
Sandoval, Elena
Affronti, Alessandro
García-Álvarez, Ana
Perdomo, Juan
Ibáñez, Cristina
Jordà, Paloma
Prat-González, Susanna
Alcocer, Jorge
Barriuso, Clemente
Llopis, Jaume
Quintana, Eduard
Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)
title Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)
title_full Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)
title_fullStr Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)
title_full_unstemmed Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)
title_short Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures (†)
title_sort outcomes of septal myectomy beyond 65 years, with and without concomitant procedures (†)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397149/
https://www.ncbi.nlm.nih.gov/pubmed/34441795
http://dx.doi.org/10.3390/jcm10163499
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