Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
Postoperative and long-term prognosis of myotomy-myomectomy for obstructive hypertrophic cardiomyopathy: influence of associated mitral valve replacement
H^pital Cardiovasculaire et Pneumologique Lyon, France
Received 8 April 1993; .
Correspondence: François Delahaye, Hôpital Cardiovasculaire et Pneumologique, BP Lyon Montchat, 69394-Lyon Cédex 03, France
Abstract
Several surgical techniques have been proposedfor obstructive hypertrophic cardiomyopathy (OHCM): myotomy, mitral valve replacement (MVR), or myotomy-myomectomy (MM). We reviewed our series of47 patients who had undergone surgery in order to determine their prognosis and to know whether MVR+MM was better than MM only.
Left intraventricular gradient decreased from 86±34 mmHg to 15±20 mmHg (P<0.0001). Postoperatively, three patients died from low cardiac output (6.4%);five died later. Annual mortality (including postoperative deaths) was 3.0%. Follow-up was 5.7±0.7 years. Survival was 87±11% at 12 years. After operation, 91% had NYHA class I or II dyspnoea (before surgery this had been 28%); chest pain was CCS class I in 88% (vs 47%); 12% hadhadsyncope since operation (vs 53%).
The gradient decrease was larger in the MM+MVR group (P<0.05). Survival and functional improvement were similar in the two groups. Mitral regurgitation decreased from 2.7 to 0 in the MM+MVR group (P<0.0001), whereas it decreased from 1.5 to 1.2 in the MM group (ns).
MM appears to be the procedure of choice. When mitral regurgitation is important or when an intrinsic disease of the mitral valve exists, the addition of M VR should be considered.
Key Words: Obstructive hypertrophic cardiomyopathy • myotomy-myomectomy • mitral valve replacement
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