Sawma Tedy, Schaff Hartzell V, Karadzha Anastasiia, Danesh Sina, Todd Austin, Ommen Steve R, Dearani Joseph A, Bagameri Gabor, Geske Jeffrey B
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
J Thorac Cardiovasc Surg. 2025 Mar 27. doi: 10.1016/j.jtcvs.2025.02.024.
To describe the clinical characteristics of patients with obstructive hypertrophic cardiomyopathy and less severe hypertrophy (septal thickness <15 mm) undergoing transaortic septal myectomy, explore possible mechanisms of obstruction, and assess operative outcomes.
We identified 51 consecutive patients with septal thicknesses <15 mm who underwent septal myectomy for obstructive hypertrophic cardiomyopathy between 2000 and 2021. They were matched in a 1:2 ratio with patients with obstructive hypertrophic cardiomyopathy with septal thickness ≥15 mm undergoing myectomy.
After propensity matching, the preoperative left ventricular outflow tract (LVOT) gradient and severity of mitral valve regurgitation were similar in the 2 groups, but patients with less hypertrophy were more likely to have latent obstruction (55% vs 30%; P = .004). Both propensity score-matched groups had similar mitral valve anterior leaflet lengths (27 mm in both; P = .4). Patients with lesser hypertrophy had more acute angulation between the septum and the LVOT tract (118° vs 130°; P < .001). There was no significant difference in operative outcomes (bypass time median, 31 vs 34 minutes; P = .4), crossclamp time was 25 minutes in both; (P = .5), nor postoperative complications, including iatrogenic ventricular septal defect (1 [2%] vs 0 [0%]; P = .3). LVOT gradient before discharge was similar in both groups (median gradient, 0 mm Hg in both; P = .1). No patients died during their hospital stay.
Severe LVOT obstruction in patients with hypertrophic cardiomyopathy can occur in the absence of significant septal hypertrophy, particularly in women with acute LVOT angulation. Extended septal myectomy can be performed safely in these patients, with favorable outcomes, and mitral valve replacement is not necessary for most patients.
描述接受经主动脉间隔心肌切除术的梗阻性肥厚型心肌病且肥厚程度较轻（室间隔厚度<15mm）患者的临床特征，探讨梗阻的可能机制，并评估手术效果。
我们确定了2000年至2021年间连续51例室间隔厚度<15mm且因梗阻性肥厚型心肌病接受间隔心肌切除术的患者。他们与室间隔厚度≥15mm且接受心肌切除术的梗阻性肥厚型心肌病患者按1:2的比例进行匹配。
倾向评分匹配后，两组术前左心室流出道（LVOT）梯度和二尖瓣反流严重程度相似，但肥厚程度较轻的患者更易出现潜在梗阻（55%对30%；P = 0.004）。两个倾向评分匹配组的二尖瓣前叶长度相似（均为27mm；P = 0.4）。肥厚程度较轻的患者室间隔与LVOT道之间的夹角更锐（118°对130°；P < 0.001）。手术效果无显著差异（体外循环时间中位数，31对34分钟；P = 0.4），两组的主动脉阻断时间均为25分钟（P = 0.5），术后并发症也无差异，包括医源性室间隔缺损（1例[2%]对0例[0%]；P = 0.3）。两组出院前LVOT梯度相似（梯度中位数均为0mmHg；P = 0.1）。住院期间无患者死亡。
肥厚型心肌病患者即使没有明显的室间隔肥厚也可能发生严重的LVOT梗阻，尤其是在LVOT夹角较锐的女性患者中。对于这些患者可以安全地进行扩大的间隔心肌切除术，效果良好，且大多数患者无需进行二尖瓣置换。
