Comparative assessment of different surgical treatment methods in obstructive hypertrophic cardiomyopathy

• Dzhordzhikiia R.K.
• Volodyukhin M.Yu.
• Safarova D.F.
• Khayrullin R.N.
• Velieva L.M.

Abstract

Aim - to evaluate and compare the effectiveness of open and endovascular methods of surgical treatment, treatment of early and distant cases in patients with hypertrophic obstructive cardiomyopathy (HOCM).

Material and methods. A prospective cohort of the study included 60 patients with hypertrophic obstructive cardiomyopathy being treated in the period from 2011 to 2018 at the Interregional Clinical Diagnostic Center, Kazan. All patients were divided into 2 groups. The average age of patients in the 1^st group was 54.1±13.8 years, in the 2^nd 52.6±9.2 years. The 1^st group included 30 patients (14 men, 16 women), who had underwent Morrow septal myectomy in with/without a plastic mitral valve; the 2^nd group included 30 patients (13 men, 17 women), who had underwent transcatheter alcohol ablation. The follow-up of patients took place in an early postoperative period and after 6, 12, 24, 36, 60 months.

Results. The pressure gradient of the excretory tract after surgery in the 1^st group decreased from 103.7±28.6 to 17.8±9.3 mm Hg (p=0.0001), in the 2^nd - from 91.8±31.6 to 22.8±5.5 mm Hg (p=0.0001), the thickness of the interventricular septum in the 1^st group decreased from 2.4±0.3 to 1.6±0.2 mm (p=0.0001), in the 2^nd from 1.9±0.4 to 1.7±0.2 mm (p=0.0001), the degree of mitral regurgitation decreased from 2.3±0.4 to 1.5±0.3 in the 1^st group (p=0.0001), in the 2^nd - from 1.9±0.5 to 1.7±0.4 (p=0.005), the size of the left atrium decreased from 4.6±0.6 to 4,4±0,5 cm (p=0.1302) in the 1^st group, in the 2^nd - from 4.1±0.4 to 4.0±0.3 cm (p=0.2235). In the early postoperative period complete left bundle-branch block was found in 60% of cases in the 1^st group, in 13% of cases in the 2^nd group (p=0.0001), complete right bundle-branch block was not observed in the 1^st group, in the 2^nd it was observed in 77% of cases (p=0.0001). The blockade was necessary in 2 cases in 1^st group and in 6 cases in the 2^nd group (p=0.1331). There was no hospital mortality. In the long-term period of 1-5 years no deaths occurred. In the distant period, mitral insufficiency (p=0.0001) and the size of the left atrium (p=0.0009) gradually increased in the 2^nd group. Functional class decreased from III-IV to I-II NYHA.

Conclusions. Septal myectomy and alcohol ablation are effective methods of surgical treatment of obstructive hypertrophic cardiomyopathy in strictly selected patients. Preference should be given to septal myectomy. Alcohol ablation can be used at high risk of open surgery.

Keywords:hypertrophic cardiomyopathy, obstruction of the left ventricular tract, septal myoectomy, alcohol ablation

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