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3 . 2022

Combined operations for hypertrophic cardiomyopathy

Abstract

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  (in Russian)

References

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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.

CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Вскрытие
Medicine today

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