肥厚性梗阻性心肌病患者手术的短期和中期结果

Short and medium term outcomes of surgery for patients with hypertrophic obstructive cardiomyopathy.

作者信息

Parry Dominic J, Raskin Robert E, Poynter Jeffery A, Ribero Igo B, Bajona Pietro, Rakowski Harry, Woo Anna, Ralph-Edwards Anthony

机构信息

Department of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

出版信息

Ann Thorac Surg. 2015 Apr;99(4):1213-9. doi: 10.1016/j.athoracsur.2014.11.020. Epub 2015 Feb 10.

DOI:10.1016/j.athoracsur.2014.11.020

PMID:25678500

Abstract

BACKGROUND

We report one surgeon's experience of corrective surgery for hypertrophic obstructive cardiomyopathy (HOCM) over a 10-year span and comment on factors that influence longer term outcomes. Septal myectomy (SM) and adjunctive procedures, including shortening of the aorta, a novel technique in HOCM patients, are described.

METHODS

Perioperative data were obtained by retrospective review of institutional surgical databases between 2001 and 2011. Review of most recent echocardiogram and clinical status by telephone interview was performed.

RESULTS

A total of 211 patients underwent SM for HOCM. There was a bimodal age distribution related to sex; mean age for males and females was 46 ± 13 and 54 ± 14 years, respectively (p < 0.001). Functional New York Heart Association (NYHA) class improved significantly after surgery; 79% were in class III-IV preoperatively and 84% were in class I-II at follow-up (p < 0.001). Sixty percent had angina of Canadian Cardiovascular Society (CCS) grade III-IV preoperatively and 89% were in CCS I-II at follow-up (p < 0.001). There were significant improvements in resting left ventricular outflow tract gradient (64 ± 36 to 5 ± 5 mm Hg, p < 0.001), right ventricular systolic pressure (36 ± 7.3 to 32 ± 8 mm Hg, p < 0.001), left atrial size (4.6 ± 0.7 to 4.3 ± 0.6 cm, p < 0.001), and grade of mitral regurgitation (moderate to severe mitral regurgitation 28% to 3.5%, p < 0.001). In-hospital mortality was 0.5%, 1 year survival 98.6%, and 5-year survival 98.1%. Predictors of worse clinical outcomes were preoperative NYHA and CCS class III-IV (p < 0.001, p = 0.05), new onset atrial fibrillation (p < 0.001), and female sex (p = 0.03).

CONCLUSIONS

Septal myectomy in patients with obstructive HOCM offers excellent symptom relief and minimal operative risk.

摘要

背景

我们报告了一位外科医生在10年期间对肥厚性梗阻性心肌病（HOCM）进行矫正手术的经验，并对影响长期预后的因素进行了评论。描述了室间隔心肌切除术（SM）及辅助手术，包括主动脉缩短术，这是一种针对HOCM患者的新技术。

方法

通过回顾2001年至2011年机构手术数据库获得围手术期数据。通过电话访谈对最新的超声心动图和临床状况进行了评估。

结果

共有211例患者因HOCM接受了SM手术。年龄分布呈与性别相关的双峰模式；男性和女性的平均年龄分别为46±13岁和54±14岁（p<0.001）。纽约心脏协会（NYHA）功能分级术后显著改善；术前79%为III-IV级，随访时84%为I-II级（p<0.001）。术前60%的患者加拿大心血管学会（CCS）心绞痛分级为III-IV级，随访时89%为CCS I-II级（p<0.001）。静息左心室流出道压差（64±36至5±5mmHg，p<0.001）、右心室收缩压（36±7.3至32±8mmHg，p<0.001）、左心房大小（4.6±0.7至4.3±0.6cm，p<0.001）和二尖瓣反流分级（中度至重度二尖瓣反流从28%降至3.5%，p<0.001）均有显著改善。住院死亡率为0.5%，1年生存率为98.6%，5年生存率为98.1%。临床预后较差的预测因素为术前NYHA和CCS III-IV级（p<0.001，p=0.05）、新发房颤（p<0.001）和女性（p=0.03）。