外科室间隔心肌切除术对梗阻性肥厚型心肌病患者生存的长期影响。
Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy.
作者信息
Ommen Steve R, Maron Barry J, Olivotto Iacopo, Maron Martin S, Cecchi Franco, Betocchi Sandro, Gersh Bernard J, Ackerman Michael J, McCully Robert B, Dearani Joseph A, Schaff Hartzell V, Danielson Gordon K, Tajik A Jamil, Nishimura Rick A
机构信息
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
出版信息
J Am Coll Cardiol. 2005 Aug 2;46(3):470-6. doi: 10.1016/j.jacc.2005.02.090.
OBJECTIVES
This study sought to determine the impact of surgical myectomy on long-term survival in hypertrophic cardiomyopathy (HCM).
BACKGROUND
Left ventricular (LV) outflow tract obstruction in HCM increases the likelihood of heart failure and cardiovascular death. Although surgical myectomy is the primary treatment for amelioration of outflow obstruction and advanced drug-refractory heart failure symptoms, its impact on long-term survival remains unresolved.
METHODS
Total and HCM-related mortality were compared in three subgroups comprised of 1,337 consecutive HCM patients evaluated from 1983 to 2001: 1) surgical myectomy (n = 289); 2) LV outflow obstruction without operation (n = 228); and 3) nonobstructive (n = 820). Mean follow-up duration was 6 +/- 6 years.
RESULTS
Including two operative deaths (procedural mortality, 0.8%), 1-, 5-, and 10-year overall survival after myectomy was 98%, 96%, and 83%, respectively, and did not differ from that of the general U.S. population matched for age and gender (p = 0.2) nor from patients with nonobstructive HCM (p = 0.8). Compared to nonoperated obstructive HCM patients, myectomy patients experienced superior survival free from all-cause mortality (98%, 96%, and 83% vs. 90%, 79%, and 61%, respectively; p < 0.001), HCM-related mortality (99%, 98%, and 95% vs. 94%, 89%, and 73%, respectively; p < 0.001), and sudden cardiac death (100%, 99%, and 99% vs. 97%, 93%, and 89%, respectively; p = 0.003). Multivariate analysis showed myectomy to have a strong, independent association with survival (hazard ratio 0.43; p < 0.001).
CONCLUSIONS
Surgical myectomy performed to relieve outflow obstruction and severe symptoms in HCM was associated with long-term survival equivalent to that of the general population, and superior to obstructive HCM without operation. In this retrospective study, septal myectomy seems to reduce mortality risk in severely symptomatic patients with obstructive HCM.
目的
本研究旨在确定外科心肌切除术对肥厚型心肌病（HCM）患者长期生存的影响。
背景
HCM患者的左心室（LV）流出道梗阻会增加心力衰竭和心血管死亡的可能性。尽管外科心肌切除术是改善流出道梗阻和治疗难治性心力衰竭症状的主要治疗方法，但其对长期生存的影响仍不明确。
方法
对1983年至2001年间连续评估的1337例HCM患者组成的三个亚组的全因死亡率和HCM相关死亡率进行比较：1）外科心肌切除术组（n = 289）；2）未手术的LV流出道梗阻组（n = 228）；3）非梗阻组（n = 820）。平均随访时间为6±6年。
结果
包括2例手术死亡（手术死亡率为0.8%），心肌切除术后1年、5年和10年的总生存率分别为98%、96%和83%，与年龄和性别匹配的美国普通人群无差异（p = 0.2），与非梗阻性HCM患者也无差异（p = 0.8）。与未手术的梗阻性HCM患者相比，心肌切除术患者的全因死亡率生存率更高（分别为98%、96%和83% vs. 90%、79%和61%；p < 0.001），HCM相关死亡率生存率更高（分别为99%、98%和95% vs. 94%、89%和73%；p < 0.001），心源性猝死生存率更高（分别为100%、99%和99% vs. 97%、93%和89%；p = 0.003）。多因素分析显示心肌切除术与生存率有强烈的独立相关性（风险比0.43；p < 0.001）。
结论
为缓解HCM患者的流出道梗阻和严重症状而进行的外科心肌切除术与普通人群的长期生存率相当，且优于未手术的梗阻性HCM患者。在这项回顾性研究中，间隔心肌切除术似乎可降低严重症状性梗阻性HCM患者的死亡风险。
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