Combined operations for hypertrophic cardiomyopathy
Background. Hypertrophic cardiomyopathy (HCM) is the most common
genetically determined non-ischemic myocardial disease with progredient course.
Open-heart surgical treatment of this disease – myectomy under cardiopulmonary
bypass, is increasingly used to treat HCM patients. Nowadays myectomy is an
essential part of surgical activity in expert cardiac surgery centers.
Aim. To study the frequency and spectrum of combined
surgery in HCM patients, and to analyze the causes of such a necessity.
Material and methods.
We have analyzed the
spectrum of surgical procedures performed in 201 HCM patients (13–74 y.o.) who
underwent a surgical remodeling of the left ventricle. Diagnosis was
established based on detailed clinical and instrumental examination in
accordance with current guidelines. It included general examination, personal
and family history taking, resting and 24-hours ECG monitoring, transthoracic
and transesophageal (intraoperative) EchoCG, cardiac MRI with gadolinium
enhancement, molecular genetic study.
Results. Additional cardiosurgical procedures along with
myectomy were performed in 71 patients (35.3%). Spectrum of combined
operations: correction of the mitral valve organic lesions -– 14 patients,
aortic valve plasty or replacement – 11 patients, CABG – 15 patients, pacemaker
implantation – 13 patients , and ICD – 18 patients.
Conclusion. The need for combined surgery can be both a
consequence of the progressive nature of HCM (mitral valve correction,
pacemaker or ICD implantations), and the existence of an independent comorbid
pathology (CABG, aortic valve correction). The implementation of these additional
surgical procedures is mandatory and does not affect the immediate and
long-term (up to 5 years) results of the myectomy.
Keywords:primary cardiomyopathy; hypertrophic cardiomyopathy; septal myectomy; left ventricular remodeling; combined surgery
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Dzemeshkevich S.L., Motreva A.P., Мартьянова Yu.B., Kalmykova O.V., Sadekova M.A., Zaklyazminskaya
E.V. Combined operations for hypertrophic cardiomyopathy. Clinical and
Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 59–63. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-59-63
1. Braunwald E. The war against heart failure: the Lancet lecture. Lancet. 2015; 385: 812–24.
2. Maron B.J., Rowin E.J., Casey S.A., et al. How hypertrophic cardiomyopathy became a contemporary treatable genetic disease with low mortality (shaped by 50 years of clinical research and practice). JAMA Cardiol. 2016; 1 (1): 98–105.
3. Raeisi-Giglou P., Rodriges E.R., Black-Stone E.H., et al. Verification for new heart transplantation allocation system. J Am Coll Cardiol. 2017; 5: 904–13.
4. Dzemeshkevich S.L., Frolova Yu.V., Kim S.Yu., et al. Anatomical and morphological signs of a diffuse-generalized form of hypertrophic cardiomyopathy. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2015; 20 (5): 58–63. (in Russian)
5. Dzemeshkevich S.L., Frolova Yu.V., Sinitsin V.E., et al. Reconstructive surgery for the diffuse-generalized form of hypertrophic cardiomyopathy. WSCTS J. 2017; 1 (2): 31–5.