Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Cardiovascular Surgery Center Beijing Anzhen Hospital, Capital Medical University Beijing China.
J Am Heart Assoc. 2024 Oct 15;13(20):e036565. doi: 10.1161/JAHA.124.036565. Epub 2024 Oct 8.
The clinical characteristics and survival outcomes of patients who underwent concomitant coronary artery bypass grafting during septal myectomy have not been well studied.
We reviewed patients who underwent both septal myectomy and coronary artery bypass grafting from 2009 to 2020. Causes of concomitant grafting and their impact on survival were analyzed. The median follow-up period was 5.1 years. A total of 320 patients underwent both grafting and myectomy. Of these, 69.7% and 28.1% underwent grafting attributed to atherosclerotic coronary artery disease and myocardial bridging, respectively. Patients who underwent grafting for coronary artery disease tended to be older, had a longer bypass time, and required more grafts compared with patients undergoing procedures because of myocardial bridging (all <0.05). Postoperatively, the left ventricular outflow gradient significantly decreased from 85.4 mm Hg to 12.8 mm Hg (<0.001) without perioperative death. The cumulative survival rates were 96.2% and 97.6% at 5 years in the coronary artery disease and myocardial bridging groups, respectively, and they were comparable to that of general myectomy cohort (hazard ratio [HR], 1.06 [95% CI, 0.47-2.36], =0.895 and HR 0.75 [95% CI, 0.23-2.46], =0.636, respectively). Sudden death accounted for 45.5% (5 of 11) of postoperative mortality. Analysis of composite end point events showed decreased morbidity with at least one arterial graft in the overall cohort (HR, 0.47 [95% CI, 0.23-0.94], =0.034).
Concomitant grafting in septal myectomy was found to be a safe procedure. Patients who underwent such surgery experienced favorable postoperative outcomes comparable to those who underwent septal myectomy alone, with a 5-year survival rate of >95% and improved functional class of >90%.
同期行冠状动脉旁路移植术（CABG）的室间隔心肌切除术患者的临床特征和生存结果尚未得到充分研究。
我们回顾了 2009 年至 2020 年同期行室间隔心肌切除术和 CABG 的患者。分析了同期搭桥的原因及其对生存的影响。中位随访时间为 5.1 年。共 320 例患者同时行搭桥和心肌切除术。其中，69.7%和 28.1%的患者分别因动脉粥样硬化性冠状动脉疾病和心肌桥而行搭桥术。与因心肌桥而行搭桥术的患者相比，行搭桥术治疗冠状动脉疾病的患者年龄较大、旁路时间较长且需要更多的移植物（均<0.05）。术后左心室流出道梯度从 85.4mmHg 显著下降至 12.8mmHg（<0.001），且无围手术期死亡。在 5 年时，冠状动脉疾病和心肌桥组的累积生存率分别为 96.2%和 97.6%，与一般心肌切除术队列相当（风险比[HR]，1.06[95%可信区间，0.47-2.36]，=0.895和 HR 0.75[95%可信区间，0.23-2.46]，=0.636，分别）。术后死亡的 45.5%（11 例中的 5 例）为猝死。复合终点事件分析显示，在整个队列中至少有一条动脉移植物的患者发病率降低（HR，0.47[95%可信区间，0.23-0.94]，=0.034）。
同期行室间隔心肌切除术的搭桥术是一种安全的手术。行此类手术的患者术后结局良好，与单独行室间隔心肌切除术的患者相比，5 年生存率>95%，心功能分级改善>90%。
