Mid‐term outcomes of simultaneous coronary artery bypass graft surgery and septal myectomy in patients with hypertrophic obstructive cardiomyopathy: A case‐controlled study

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Abstract

Background

The mid‐term outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing coronary artery bypass graft (CABG) is unclear.

Materials and Methods

We studied 44 patients with HOCM and coronary artery disease (CAD) who underwent septal myectomy and CABG) between 2011 and 2017. The control group was matched in a ratio of 4:1 based on age, sex, body mass index, hypertension, and chest pain.

Results

Compared to patients without CAD, patients with CAD had a higher long‐term cardiovascular mortality rate (0.6% vs 6.8%, P = 0.03; hazard ratio [HR] = 8.16, 95% confidence interval [CI]: 1.27‐74.48, P = 0.03). In addition, 10 out of 176 (5.7%) patients without CAD and nine out of 44 (20.5%) patients with CAD achieved the secondary endpoints (progressive heart failure, unexplained syncope, stroke, atrial fibrillation, and myocardial infarction) (HR = 2.89, 95%CI: 1.03‐8.12, P = 0.04). The 5‐year survival rate and cardiovascular event‐free survival rate were significantly higher in patients without CAD than in those with CAD (97.4% vs 93.9%, P = 0.03; 89.2% vs 80.1%; P = 0.04). In the multivariate analysis, presence of CAD, New York Heart Association class, and left atrial diameter were predictors of combined cardiovascular events when adjusted for age and male sex.

Conclusions

The cardiovascular death and cardiovascular events are significantly increased in patients with HOCM and CAD who underwent CABG at the time of septal myectomy.

Related collections

Most cited references 14

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Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease.

Paul Sorajja, Steve R. Ommen, Rick A. Nishimura … (2003)

Adult patients with hypertrophic cardiomyopathy (HCM) may develop concomitant atherosclerotic coronary artery disease (CAD). There is a paucity of data on the clinical outcomes of HCM patients who have CAD.

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Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death.

Cristina Basso, Domenico Corrado, Gaetano Thiene … (2009)

The clinical significance attributable to myocardial bridging of left anterior descending coronary artery in hypertrophic cardiomyopathy (HCM) remains controversial. Prevalence and depth of coronary artery bridges (CBs) were assessed in 255 hearts, including 115 with HCM (median age 29, range 5-90; 75% male), and 140 controls. Coronary artery bridges were more common in HCM (47/115; 41%) than in patients who died of a variety of non-HCM-related causes (21/100; 21%; P = 0.002), or in patients with congenital aortic stenosis and left ventricular (LV) hypertrophy (5/40; 12%; P = 0.001). Among the HCM hearts, CBs were present in 33 of 77 patients (43%) with sudden death, in 10 of 27 (37%) with heart failure death (or heart transplantation), and in 4 of 11 (36%) with other modes of death (P = 0.826). Deeply embedded CBs (> or =2 mm) occurred with similar frequency in HCM patients with sudden (21 of 77; 27%) or heart failure death (5 of 27; 13%; P = 0.191). In sudden death patients, the presence of CB was unrelated to gender (33% in women and 45% in men, P = 0.406) and age (41% or =18 years; P = 0.827). In this morphological analysis of more than 250 hearts, CBs are a frequent component of phenotypically expressed HCM, and more common than in other disorders with or without LV hypertrophy. Although no systematic association with HCM-related sudden death is evident, our findings do not exclude the possibility that CB could contribute to increased risk in some individual patients, potentially impacting management decision-making on a case-by-case basis.

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Results of surgical septal myectomy for obstructive hypertrophic cardiomyopathy: the Tufts experience

Hassan Rastegar, Griffin Boll, Ethan J Rowin … (2017)

Background For over 50 years, surgical septal myectomy has been the preferred treatment for drug-refractory heart failure symptoms in patients with obstructive hypertrophic cardiomyopathy (HCM). Over this time in the United States, the majority of myectomy operations have been performed in a small number of select referral centers. Methods We have taken the opportunity to report results from the relatively new Tufts HCM Center and surgical program, incorporated 13 years ago, during which 507 myectomies (52±14 years of age; 56% male) were performed by one cardiothoracic surgeon, Dr. Hassan Rastegar. Results Resting left ventricular (LV) outflow gradients were reduced from 56±42 mmHg preoperatively to 1.2±6.8 mmHg on most recent echocardiogram 2.0±2.5 years after surgery, and 94% of patients showed clinical improvement to NYHA functional class I or II. The first 200 myectomies were performed without mortality or major complications. Among all patients, 30-day mortality rate was 0.8%. Over follow-up of 3.2±2.8 years, 11 patients died (four due to HCM causes) with long-term survival after myectomy of 94% at 5 years (95% CI: 89–96%) and 91% at 10 years (95% CI: 84–95%), which did not differ from the age- and gender-matched general U.S. population (log-rank P=0.9). Conclusions This experience demonstrates that, with the appropriate support, new HCM surgical programs can provide patients successful relief of outflow obstruction, extended longevity and restored of quality of life.

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Author and article information

Contributors

Shuiyun Wang:

ORCID: http://orcid.org/0000-0003-3928-7945

wsymd@sina.com

Journal

Journal ID (nlm-ta): J Card Surg

Journal ID (iso-abbrev): J Card Surg

Journal ID (doi): 10.1111/(ISSN)1540-8191

Journal ID (publisher-id): JOCS

Title: Journal of Cardiac Surgery

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0886-0440

ISSN (Electronic): 1540-8191

Publication date (Electronic): 12 January 2019

Publication date (Print): March 2019

Volume: 34

Issue: 3 ( doiID: 10.1111/jocs.v34.3 )

Pages: 103-109

Affiliations

[ ¹ ] Department of Cardiovascular Surgery State Key Laboratory of Cardiovascular Disease Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

[ ² ] Department of Cardiovascular Surgery Mayo Clinic Rochester Minnesota

[ ³ ] Department of Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Author notes

[*] [* ] Correspondence

Shuiyun Wang MD, Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Rd, Xicheng District, Beijing 100037, China.

Email: wsymd@ 123456sina.com

Author information

Shuiyun Wang http://orcid.org/0000-0003-3928-7945

Article

Publisher ID: JOCS13988

DOI: 10.1111/jocs.13988

PMC ID: 6590250

PubMed ID: 30636173

SO-VID: 18744c72-e2ce-4ceb-b696-70924afbc76b

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Page count

Figures: 1, Tables: 6, Pages: 7, Words: 3337

Funding

Funded by: National Natural Science Foundation of China

Award ID: 81570276

Custom metadata

source-schema-version-number 2.0

component-id jocs13988

cover-date March 2019

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:24.06.2019

Keywords: coronary artery disease,coronary artery bypass grafting,hypertrophic cardiomyopathy,septal myectomy

Data availability:

Keywords: coronary artery disease, coronary artery bypass grafting, hypertrophic cardiomyopathy, septal myectomy