Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States

Lawrence M. Wei, Dylan P. Thibault, J. Scott Rankin, Mohamad Alkhouli, Harold G. Roberts, Sreekanth Vemulapalli, Babatunde Yerokun, Niv Ad, Hartzell V. Schaff, Nicholas G. Smedira, Hiroo Takayama, Patrick M McCarthy, Vinod H. Thourani, Gorav Ailawadi, Jeffrey P. Jacobs, Vinay Badhwar*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The primary surgical therapy for hypertrophic cardiomyopathy with obstruction is septal myectomy (SM). The current outcomes of SM with and without concomitant mitral operations in the United States was examined using The Society of Thoracic Surgeons database. Methods: From July 2014 through June 2017, 4,274 SM operations were performed. Emergent status, endocarditis, aortic stenosis, and planned aortic valve operations were excluded. In the final cohort of 2,382 patients, 1,581 (66.4%) received SM alone (group 1), and 801 (33.6%) had SM with mitral valve repair or replacement (group 2). Group 2 was subdivided into mitral valve repair (MVr [n = 500]) and mitral valve replacement (MVR [n = 301]). Baseline characteristics were compared and risk-adjusted operative mortality and major morbidity were evaluated between treatment groups. Results: Baseline comorbidity was lower in group 1 versus group 2 and for MVr versus MVR. Operative mortality and major morbidity was lower for group 1 versus 2 (1.6% versus 2.8%, p = 0.046, and 10.9% versus 20.0%, p < 0.001, respectively). For patients with severe 3-4+ mitral regurgitation, SM alone was effective in reducing mitral regurgitation in 85.5% (355 of 415), and SM with MVr was effective in 88.0% (176 of 200; p = 0.4061). After risk adjustment, odds ratio for composite of mortality and major morbidity for group 2 versus group 1 was 1.8 (95% confidence interval: 1.4 to 2.4, p < 0.0001). Conclusions: Septal myectomy for hypertrophic cardiomyopathy is safe. Septal myectomy alone may have risk-adjusted outcome advantages over SM with mitral valve repair or replacement. Septal myectomy and SM with MVr provide similar reduction in mitral regurgitation. Further longitudinal analyses are required to define technical efficacy and outcomes in selected pathoanatomic groups.

Original languageEnglish (US)
Pages (from-to)460-466
Number of pages7
JournalAnnals of Thoracic Surgery
Volume107
Issue number2
DOIs
StatePublished - Feb 1 2019

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Hypertrophic Cardiomyopathy
Mitral Valve
Mitral Valve Insufficiency
Morbidity
Mortality
Risk Adjustment
Aortic Valve Stenosis
Endocarditis
Aortic Valve
Comorbidity
Odds Ratio
Databases
Confidence Intervals
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Wei, L. M., Thibault, D. P., Rankin, J. S., Alkhouli, M., Roberts, H. G., Vemulapalli, S., ... Badhwar, V. (2019). Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States. Annals of Thoracic Surgery, 107(2), 460-466. https://doi.org/10.1016/j.athoracsur.2018.08.068
Wei, Lawrence M. ; Thibault, Dylan P. ; Rankin, J. Scott ; Alkhouli, Mohamad ; Roberts, Harold G. ; Vemulapalli, Sreekanth ; Yerokun, Babatunde ; Ad, Niv ; Schaff, Hartzell V. ; Smedira, Nicholas G. ; Takayama, Hiroo ; McCarthy, Patrick M ; Thourani, Vinod H. ; Ailawadi, Gorav ; Jacobs, Jeffrey P. ; Badhwar, Vinay. / Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States. In: Annals of Thoracic Surgery. 2019 ; Vol. 107, No. 2. pp. 460-466.
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title = "Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States",
abstract = "Background: The primary surgical therapy for hypertrophic cardiomyopathy with obstruction is septal myectomy (SM). The current outcomes of SM with and without concomitant mitral operations in the United States was examined using The Society of Thoracic Surgeons database. Methods: From July 2014 through June 2017, 4,274 SM operations were performed. Emergent status, endocarditis, aortic stenosis, and planned aortic valve operations were excluded. In the final cohort of 2,382 patients, 1,581 (66.4{\%}) received SM alone (group 1), and 801 (33.6{\%}) had SM with mitral valve repair or replacement (group 2). Group 2 was subdivided into mitral valve repair (MVr [n = 500]) and mitral valve replacement (MVR [n = 301]). Baseline characteristics were compared and risk-adjusted operative mortality and major morbidity were evaluated between treatment groups. Results: Baseline comorbidity was lower in group 1 versus group 2 and for MVr versus MVR. Operative mortality and major morbidity was lower for group 1 versus 2 (1.6{\%} versus 2.8{\%}, p = 0.046, and 10.9{\%} versus 20.0{\%}, p < 0.001, respectively). For patients with severe 3-4+ mitral regurgitation, SM alone was effective in reducing mitral regurgitation in 85.5{\%} (355 of 415), and SM with MVr was effective in 88.0{\%} (176 of 200; p = 0.4061). After risk adjustment, odds ratio for composite of mortality and major morbidity for group 2 versus group 1 was 1.8 (95{\%} confidence interval: 1.4 to 2.4, p < 0.0001). Conclusions: Septal myectomy for hypertrophic cardiomyopathy is safe. Septal myectomy alone may have risk-adjusted outcome advantages over SM with mitral valve repair or replacement. Septal myectomy and SM with MVr provide similar reduction in mitral regurgitation. Further longitudinal analyses are required to define technical efficacy and outcomes in selected pathoanatomic groups.",
author = "Wei, {Lawrence M.} and Thibault, {Dylan P.} and Rankin, {J. Scott} and Mohamad Alkhouli and Roberts, {Harold G.} and Sreekanth Vemulapalli and Babatunde Yerokun and Niv Ad and Schaff, {Hartzell V.} and Smedira, {Nicholas G.} and Hiroo Takayama and McCarthy, {Patrick M} and Thourani, {Vinod H.} and Gorav Ailawadi and Jacobs, {Jeffrey P.} and Vinay Badhwar",
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Wei, LM, Thibault, DP, Rankin, JS, Alkhouli, M, Roberts, HG, Vemulapalli, S, Yerokun, B, Ad, N, Schaff, HV, Smedira, NG, Takayama, H, McCarthy, PM, Thourani, VH, Ailawadi, G, Jacobs, JP & Badhwar, V 2019, 'Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States', Annals of Thoracic Surgery, vol. 107, no. 2, pp. 460-466. https://doi.org/10.1016/j.athoracsur.2018.08.068

Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States. / Wei, Lawrence M.; Thibault, Dylan P.; Rankin, J. Scott; Alkhouli, Mohamad; Roberts, Harold G.; Vemulapalli, Sreekanth; Yerokun, Babatunde; Ad, Niv; Schaff, Hartzell V.; Smedira, Nicholas G.; Takayama, Hiroo; McCarthy, Patrick M; Thourani, Vinod H.; Ailawadi, Gorav; Jacobs, Jeffrey P.; Badhwar, Vinay.

In: Annals of Thoracic Surgery, Vol. 107, No. 2, 01.02.2019, p. 460-466.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States

AU - Wei, Lawrence M.

AU - Thibault, Dylan P.

AU - Rankin, J. Scott

AU - Alkhouli, Mohamad

AU - Roberts, Harold G.

AU - Vemulapalli, Sreekanth

AU - Yerokun, Babatunde

AU - Ad, Niv

AU - Schaff, Hartzell V.

AU - Smedira, Nicholas G.

AU - Takayama, Hiroo

AU - McCarthy, Patrick M

AU - Thourani, Vinod H.

AU - Ailawadi, Gorav

AU - Jacobs, Jeffrey P.

AU - Badhwar, Vinay

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: The primary surgical therapy for hypertrophic cardiomyopathy with obstruction is septal myectomy (SM). The current outcomes of SM with and without concomitant mitral operations in the United States was examined using The Society of Thoracic Surgeons database. Methods: From July 2014 through June 2017, 4,274 SM operations were performed. Emergent status, endocarditis, aortic stenosis, and planned aortic valve operations were excluded. In the final cohort of 2,382 patients, 1,581 (66.4%) received SM alone (group 1), and 801 (33.6%) had SM with mitral valve repair or replacement (group 2). Group 2 was subdivided into mitral valve repair (MVr [n = 500]) and mitral valve replacement (MVR [n = 301]). Baseline characteristics were compared and risk-adjusted operative mortality and major morbidity were evaluated between treatment groups. Results: Baseline comorbidity was lower in group 1 versus group 2 and for MVr versus MVR. Operative mortality and major morbidity was lower for group 1 versus 2 (1.6% versus 2.8%, p = 0.046, and 10.9% versus 20.0%, p < 0.001, respectively). For patients with severe 3-4+ mitral regurgitation, SM alone was effective in reducing mitral regurgitation in 85.5% (355 of 415), and SM with MVr was effective in 88.0% (176 of 200; p = 0.4061). After risk adjustment, odds ratio for composite of mortality and major morbidity for group 2 versus group 1 was 1.8 (95% confidence interval: 1.4 to 2.4, p < 0.0001). Conclusions: Septal myectomy for hypertrophic cardiomyopathy is safe. Septal myectomy alone may have risk-adjusted outcome advantages over SM with mitral valve repair or replacement. Septal myectomy and SM with MVr provide similar reduction in mitral regurgitation. Further longitudinal analyses are required to define technical efficacy and outcomes in selected pathoanatomic groups.

AB - Background: The primary surgical therapy for hypertrophic cardiomyopathy with obstruction is septal myectomy (SM). The current outcomes of SM with and without concomitant mitral operations in the United States was examined using The Society of Thoracic Surgeons database. Methods: From July 2014 through June 2017, 4,274 SM operations were performed. Emergent status, endocarditis, aortic stenosis, and planned aortic valve operations were excluded. In the final cohort of 2,382 patients, 1,581 (66.4%) received SM alone (group 1), and 801 (33.6%) had SM with mitral valve repair or replacement (group 2). Group 2 was subdivided into mitral valve repair (MVr [n = 500]) and mitral valve replacement (MVR [n = 301]). Baseline characteristics were compared and risk-adjusted operative mortality and major morbidity were evaluated between treatment groups. Results: Baseline comorbidity was lower in group 1 versus group 2 and for MVr versus MVR. Operative mortality and major morbidity was lower for group 1 versus 2 (1.6% versus 2.8%, p = 0.046, and 10.9% versus 20.0%, p < 0.001, respectively). For patients with severe 3-4+ mitral regurgitation, SM alone was effective in reducing mitral regurgitation in 85.5% (355 of 415), and SM with MVr was effective in 88.0% (176 of 200; p = 0.4061). After risk adjustment, odds ratio for composite of mortality and major morbidity for group 2 versus group 1 was 1.8 (95% confidence interval: 1.4 to 2.4, p < 0.0001). Conclusions: Septal myectomy for hypertrophic cardiomyopathy is safe. Septal myectomy alone may have risk-adjusted outcome advantages over SM with mitral valve repair or replacement. Septal myectomy and SM with MVr provide similar reduction in mitral regurgitation. Further longitudinal analyses are required to define technical efficacy and outcomes in selected pathoanatomic groups.

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Wei LM, Thibault DP, Rankin JS, Alkhouli M, Roberts HG, Vemulapalli S et al. Contemporary Surgical Management of Hypertrophic Cardiomyopathy in the United States. Annals of Thoracic Surgery. 2019 Feb 1;107(2):460-466. https://doi.org/10.1016/j.athoracsur.2018.08.068