Long-term Survival after Myectomy Operation

National Heart, Lung, And Blood Institute

Investigators

Linked publications, trials & patents

Abstract

Since virtually from the modern conception of hypertrophic cardiomyopathy in the early 1960s, surgical septal myectomy has been the primary gold standard treatment to reverse drug-refractory heart failure symptoms by permanent and complete relief of left ventricular (LV) outflow obstruction. However, despite this long time period, myectomy studies have generally reported follow-up data over relatively short periods with few assessments of treatment outcomes across multiple management eras. Therefore, in this protocol we have taken the unique opportunity to compare truly long-term survival outcomes of the historic surgical myectomy series of Dr. Andrew G. Morrow at NIH with an example of more contemporary surgical results, and in the process demonstrating evolution of the myectomy operation. We evaluated the results of the 249 NIH patients who comprise the study group. Survival post-myectomy from all causes was 67% (95% CI: 61,73) at 10 years; 55%, (95% CI: 48, 60) at 15 years; and 24% (95% CI: 19, 30) at 25 years. All-cause mortality rate was 3.1%/year, exceeding that expected in a general age-adjusted and gender-matched U.S. population from the same time period (SMR: 3.94 95% CI: 3.1, 4.8; log-rank p < 0.001). Maturation of surgical septal myectomy over 60 years with enhanced operator expertise has resulted in a low risk:high benefit option for severely symptomatic patients with obstructive hypertrophic cardiomyopathy when performed in experienced centers.