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Ten years of extended myectomy for the treatment of hypertrophic obstructive cardiomyopathy
Session:
Painel 11 -Cardiologia Intervenção 1
Speaker:
José Máximo
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Posters
FP Number:
---
Authors:
José Máximo; Armando Abreu; Paulo Pinho; Jorge Casanova
Abstract
<p><strong>Introduction</strong></p> <p>Hypertrophic obstructivecardiomyopathy (HOCM)is a hereditary condition affecting the heart and surgery plays a major role in its treatment. Gender differences in clinical presentation and treatment outcomes are currently in debate. Our aim is to describe the population of HOCMpatients in whom extended myectomy was performed in our tertiary care facility, between 2009 and 2019, and characterize sex differences before and after surgical treatment.</p> <p><strong>Methods</strong></p> <p>The data was collected from the clinical records (n = 33), in all patients with a main operative diagnosis of HOCM in the last 10 years. Pre-operative demographics, clinical and diagnostic work-up information<s>,</s>intra-operative variables and post-operative outcomes were collected. Statistical analysis was performed using appropriate non-parametric tests in SPSS software (v24.0).</p> <p><strong>Results</strong></p> <p>No intraoperative deaths were registered; hospital mortality was 3% (one patient; due to arrhythmia) and three deaths occurred during a median follow up time of 4.5 years (two cardiac and one respiratory in nature). Median time until hospital discharge was 8 days. From the 33 patients included in the analysis, 14 were male and 19 females. Female patients are older (median age 65 [40.6-66.5] vs 60 [62-72]years, p=0.05) and more symptomatic than male patients at the time of surgery (84.2% of females vs 28.6% of males in class III-IV of New York Heart Association [NYHA]; p=0.003); their pre-operative study showed higher left atrium dimension (median 30.38 [26-31.7] vs 24.7 [24-27.7] mm/m<sup>2</sup>,p=0.002) and interventricular septum thickness (median 11.9 [11.2-13]vs 9.4 [8.1-12.1] mm/m<sup>2</sup>,p=0.028) to body surface ratio and a higher incidence of atrial fibrillation (31.6% vs 0%, p=0.027). During surgery, although extracorporeal circulation and aortic cross-clamp times did not differ significantly, females required more blood transfusions (median 2 [0-3] vs 0 [0-1] red blood cells units, p=0.046). After surgery, interventricular septum and left ventricle outflow tract gradient reductions are similar between genders, but transition to lower NYHA classes is significant for females (p=0.003), but not for male patients. Although survival curves seem to diverge, this was not statistically significant.</p> <p><strong>Conclusions</strong></p> <p>Female patients seem to be in worse clinical condition upon presentation to surgery and show markers of more advanced disease. Nevertheless, after surgery, females presented greater functional improvement. We need to focus on a more comprehensive approach in patient preoperative study and increase the sensitivity for disease diagnosis in earlier stages in the female population.</p>
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