Wang Shengwei, Wang Shuiyun, Lai Yongqiang, Song Yunhu, Cui Hao, Song Changpeng, Meng Liukun, Zhu Changsheng, Wu Rong, Huang Xiaohong
Department of Cardiovascular Surgery Center, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
J Card Surg. 2021 Feb;36(2):501-508. doi: 10.1111/jocs.15226. Epub 2020 Dec 1.
Myocardial bridging (MB) is commonly treated in patients with hypertrophic cardiomyopathy. However, whether and how MB should be treated in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remain unclear.
A total of 823 adults with HOCM who underwent septal myectomy at the Fuwai Hospital from 2011 to 2017 were retrospectively studied.
Overall, 31 events occurred: 24 patients died and 7 had nonfatal myocardial infarction (MI). The 3-year cumulative event-free survival of all-cause death (97.9% vs. 100% vs. 100% vs. 98.4%, p = .89) and cardiovascular death (98.3% vs. 100% vs. 100% vs. 98.4%, p = .63) were similar among the four groups (non-MB, coronary artery bypass grafting [CABG], unroofing, untreated, respectively). However, the 3-year cumulative event-free survival of nonfatal MI (100% vs. 97.5% vs. 98.0% vs. 89.9%, p < .001) and combined endpoints (97.9% vs. 97.5% vs. 98.0% vs. 88.4%, p = .02) were significantly lowest in untreated MB (non-MB, CABG, unroofing, untreated, respectively). Cox regression analysis indicated that untreated MB was a significant independent predictor of combined endpoints (hazard ratio: 4.06, 95% confidence interval: 1.60-10.32, p < .001). Moreover, 49 patients underwent coronary artery computed tomography 1 year after surgery. The patency rate of the saphenous vein graft was significantly higher than that of the left internal mammary artery (13.3% vs. 84.2%, p < .001). No MB was detected in the unroofing group.
Surgical MB treatment could be beneficial and performed safely during septal myectomy. Myocardial unroofing is the recommended treatment for MB, and unroofing when technically possible may be preferable for long-term outcomes.
肥厚型心肌病患者常接受心肌桥（MB）治疗。然而，对于接受室间隔心肌切除术的肥厚型梗阻性心肌病（HOCM）患者，是否以及如何治疗MB仍不明确。
回顾性研究了2011年至2017年在阜外医院接受室间隔心肌切除术的823例成年HOCM患者。
总体上，发生了31起事件：24例患者死亡，7例发生非致命性心肌梗死（MI）。四组（分别为无MB、冠状动脉旁路移植术[CABG]、心肌松解术、未治疗组）的全因死亡3年累积无事件生存率（97.9%对100%对100%对98.4%，p = 0.89）和心血管死亡3年累积无事件生存率（98.3%对100%对100%对98.4%，p = 0.63）相似。然而，未治疗的MB组非致命性MI的3年累积无事件生存率（100%对97.5%对98.0%对89.9%，p < 0.001）和联合终点事件的3年累积无事件生存率（97.9%对97.5%对98.0%对88.4%，p = 0.02）显著最低（分别为无MB、CABG、心肌松解术、未治疗组）。Cox回归分析表明，未治疗的MB是联合终点事件的显著独立预测因素（风险比：4.06，95%置信区间：1.60 - 10.32，p < 0.001）。此外，49例患者术后1年接受了冠状动脉计算机断层扫描。大隐静脉移植血管的通畅率显著高于左乳内动脉（13.3%对84.2%，p < 0.001）。心肌松解术组未检测到MB。
在室间隔心肌切除术期间，手术治疗MB可能有益且安全。心肌松解术是推荐的MB治疗方法，在技术可行时进行心肌松解术可能对长期预后更有利。
