Importance of surgical expertise in septal myectomy for obstructive hypertrophic cardiomyopathy
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ORIGINAL ARTICLE
Importance of surgical expertise in septal myectomy for obstructive hypertrophic cardiomyopathy Sarah N. Yu1 · Koki Nakanishi1 · Jonathan N. Ginns3 · Michael P. Salna1 · Yuichi J. Shimada2 · Antonio Polanco1 · Yuting Chiang1 · Shepard D. Weiner2 · Hiroo Takayama1 Received: 26 November 2019 / Accepted: 10 February 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective In 2011, a multidisciplinary hypertrophic cardiomyopathy (HCM) program with a dedicated myectomy surgeon was implemented at our institution. We hypothesized that a dedicated approach allows better identification and management of mitral regurgitation (MR) during septal myectomy (SM) for obstructive HCM with significant mitral regurgitation. Methods Between 2006 and 2018, 181 patients had SM at our institution. This study consists of 53 patients with preoperative moderate or greater MR associated with systolic anterior motion who underwent isolated SM with or without mitral intervention. Patients were divided into those who underwent SM by a dedicated myectomy surgeon (group D, n = 31) or by a non-dedicated surgeon (group ND, n = 22). Primary outcome of interest was rate of mitral valve replacement (MVR) at SM. Secondary outcomes include in-hospital mortality, need for permanent pacemaker, mitral valve reoperation, and residual MR and left ventricular outflow tract gradient on postoperative echocardiography. Results 12 patients (55%) had a concomitant MVR during septal myectomy in group ND compared to 2 patients (6%) in group D (p
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