Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Eur J Cardiothorac Surg. 2013 Mar;43(3):534-40. doi: 10.1093/ejcts/ezs332. Epub 2012 Jul 3.
The aim was to assess the early and mid-term clinical effects of transaortic extended septal myectomy (TAESM) on obstructive hypertrophic cardiomyopathy (HCM) in China.
Ninety-three consecutive patients [57 men; mean age 45.8 ± 13.4 (11-74) years] with obstructive HCM underwent TAESM in Fuwai hospital. Their clinical data were analysed retrospectively. All the patients had drug-refractory symptoms and left ventricular outflow tract (LVOT) obstruction with a resting or physically provoked gradient of ≥50 mmHg. Preoperative transthoracic, intra-operative transoesophageal and postoperative transthoracic echocardiography was performed to assess LVOT gradients, septal thickness, LVOT diameter, mitral valve function, etc. Systolic anterior motion (SAM) of the anterior mitral valve leaflet had been detected in all preoperatively.
All the surgical procedures of the 93 patients were technically successful. The average length of postoperative stay was 7.8 ± 3.7 days. The 30-day and in-hospital mortality was 0%. Initial postoperative transoesophageal echocardiography (TEE) demonstrated marked reduction in LVOT gradient (91.76 ± 25.08 to 14.34 ± 13.44 mmHg, P < 0.0005) and significant improvement in mitral regurgitation (MR; P < 0.0005). Concomitant surgical procedures were carried out in 37 (39.8%). Complete atrioventricular block occurred in 3, complete left bundle branch block in 44, intraventricular conduction delay in 18, complete right bundle branch block in 2, transient renal dysfunction in 2 and transient intra-aortic-balloon-pumping was needed in 2. No other complications were observed during hospital stay. During a follow-up of 10.72 ± 11.02 (1-24) months, there were no readmissions or deaths, and all patients subjectively reported an obvious decrease in limiting symptoms and a significant increase in physical ability. At the latest follow-up, the New York Heart Association functional class decreased from 3.09 ± 0.60 (2-4) preoperatively to 1.12 ± 0.32 (1-2) (P < 0.0005); the LVOT gradient remained low at 14.78 ± 14.01 mmHg; MR remained absent (51) or at mild-(41)-to-moderate-(1) levels and SAM resolved completely in 98.9% (92 of 93) patients.
TAESM provides excellent relief from LVOT obstruction in HCM patients, with a conspicuous clinical and echocardiographic outcome at early and mid-term follow-up. For obstructive HCM and cardiac comorbidities, concomitant cardiac procedures with TAESM can be performed with low risk and satisfactory results.
评估经主动脉延伸室间隔心肌切除术（TAESM）在中国治疗梗阻性肥厚型心肌病（HCM）的早期和中期临床效果。
93 例连续梗阻性 HCM 患者[57 例男性；平均年龄 45.8 ± 13.4（11-74）岁]在阜外医院接受 TAESM。回顾性分析其临床资料。所有患者均有药物难治性症状和左心室流出道（LVOT）梗阻，静息或体力激发时压差≥50mmHg。术前、术中经胸、术后经胸超声心动图评估 LVOT 梯度、室间隔厚度、LVOT 直径、二尖瓣功能等。所有患者术前均检测到前二尖瓣叶收缩期前向运动（SAM）。
93 例患者的手术均技术成功。术后平均住院时间为 7.8 ± 3.7 天。30 天和住院死亡率均为 0%。术后即刻经食管超声心动图（TEE）显示 LVOT 梯度明显降低（91.76 ± 25.08 至 14.34 ± 13.44mmHg，P<0.0005），二尖瓣反流（MR）显著改善（P<0.0005）。37 例（39.8%）同时进行了心脏手术。术后发生完全性房室传导阻滞 3 例，完全性左束支传导阻滞 44 例，室内传导延迟 18 例，完全性右束支传导阻滞 2 例，短暂性肾功能不全 2 例，2 例需要临时主动脉内球囊反搏。住院期间无其他并发症发生。随访 10.72 ± 11.02（1-24）个月，无再入院或死亡，所有患者均自述症状明显减轻，体力活动明显增加。末次随访时，纽约心脏病协会心功能分级由术前 3.09 ± 0.60（2-4）降至 1.12 ± 0.32（1-2）（P<0.0005）；LVOT 梯度仍较低，为 14.78 ± 14.01mmHg；MR 仍为阴性（51 例）或轻度（41 例）至中度（1 例），98.9%（92/93）患者的 SAM 完全消失。
TAESM 可显著缓解 HCM 患者的 LVOT 梗阻，早期和中期随访临床和超声心动图效果显著。对于梗阻性 HCM 和心脏合并症，与 TAESM 同时进行心脏手术风险低，效果满意。
