Surgical myectomy for hypertrophic cardiomyopathy: procedural volume and outcomes
Tijn J P Heeringa, Romy R. M. J. J. Hegeman, Yvonne Koop, Sulayman el Mathari, Marieke Hoogewerf, Maaike M. Roefs, Karin C. Smits, Dorien Laenens, Giulia De Zan, Maarten J. Cramer, Marco Guglielmo, Pim van der Harst, Ilonca Vaartjes, Mostafa M. Mokhles, Patrick Klein, Niels P. van der Kaaij
Abstract
BACKGROUND AND AIMS: Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates. METHODS: All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate. RESULTS: Isolated surgical myectomy was performed in 22%, surgical myectomy with one concomitant procedure in 54%, and surgical myectomy with two or more concomitant procedures in 24%. Thirty-day complication rates concerned mortality (5%), ventricular septal defect (2%), stroke (3%), and surgical reoperation (2%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 ± 30 mmHg to 13 ± 12 mmHg postoperatively, systolic anterior motion from 80% to 8%, and mitral regurgitation grade 3 or 4 from 31% to 6%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and ≥2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95% confidence interval: 1.43-8.09); P = .007). CONCLUSIONS: Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93% of patients in this multicentre cohort. Female sex, ≥ 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted.