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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Surgical Myectomy for Hypertrofic Obstructive Cardiomyopathy
Session:
Painel 9 - Doença Valvular 5
Speaker:
André de Lima Antunes
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Antunes de Lima Antunes; David Prieto; Gonçalo Freitas Coutinho; Manuel Antunes; Pedro Engrácia Antunes
Abstract
<p><strong>Introduction</strong>: Septal myectomy is the gold standard treatment for hypertrophic obstructive cardiomyopathy. This study aimed to evaluate the results from patients with hypertrophic obstructive cardiomyopathy who underwent to septal myectomy at our institution.</p> <p><strong>Methods</strong>: A retrospective study was performed evaluating all consecutive 38 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy at our institution from January 2000 to October 2019. All patients were submmited to septal myectomy by transaortic approach. Were excluded all patients with concomitant aortic valve repair or replacement.</p> <p><strong>Results</strong>: The mean age was 58 years (10-79) and 53.3% were male. Most of the patients were in NYHA class III/IV preoperatively (76%), and 18% had a cardiodesfibrilator implantation in primary prevention context. 79% of patients had moderate to severe mitral regurgitation. 32% of patients needed a concomitant mitral valve apparatus intervention. The mean cardiopulmonary bypass time was 43min and the mean aortic clamp time was 21min. The mean ICU stay was 2 days (1-4) and the mean in-hospital stay was 6 days. Six patients (40%) needed inotropic support. There was no intra-operative mortality neither in-hospital mortality. The mean interventricular septal size reduced from 19mm (14-33) preoperative to 11mm (10-15) after myectomy. The mean resting left ventricular outflow tract gradients reduced from 81.5+/-24.4 mmHg preoperatively to 18.4+/-8.9 mmHg at discharge. There was 1 patient with conduction disorders that needed pacemaker implantation. There were no iatrogenic ventricular septal defects. Thirty-five patients (92%) were categorised as NYHA class I or II. Late survival rates at 5 and 15 years were 97.1±2.8 and 51.1±2.1% respectively.</p> <p><strong>Conclusion</strong>: At our centre, septal myectomy is associated with low operative and early mortality rates, a low risk of early adverse events, and good clinical and haemodynamic outcomes.</p>
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