학술논문
Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel.
Document Type
Academic Journal
Author
Maron BJ; Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA. Electronic address: barrymaron1@gmail.com.; Dearani JA; Mayo Clinic, Rochester, MN.; Smedira NG; Cleveland Clinic Foundation, Cleveland, Ohio.; Schaff HV; Mayo Clinic, Rochester, MN.; Wang S; Fuwai Hospital, Bejing, China.; Rastegar H; Tufts Medical Center, Boston, MA.; Ralph-Edwards A; Toronto General Hospital, Toronto Ontario, Canada.; Ferrazzi P; Policlinico de Monza, Monza, Italy.; Swistel D; New York University Langone Health, New York, NY.; Shemin RJ; UCLA Medical Center, Los Angeles, CA.; Quintana E; Hospital Clinic, deBarcelona, University of Barcelona,Spain.; Bannon PG; Royal Prince Alfred Hospital, Sydney, Australia.; Shekar PS; Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA.; Desai M; Cleveland Clinic Foundation, Cleveland, Ohio.; Roberts WC; Department of Pathology and Medicine; Baylor UniversityMedical Center, Dallas Texas.; Lever HM; Cleveland Clinic Foundation, Cleveland, Ohio.; Adler A; Toronto General Hospital, Toronto Ontario, Canada.; Rakowski H; Toronto General Hospital, Toronto Ontario, Canada.; Spirito P; Policlinico de Monza, Monza, Italy.; Nishimura RA; Mayo Clinic, Rochester, MN.; Ommen SR; Mayo Clinic, Rochester, MN.; Sherrid MV; New York University Langone Health, New York, NY.; Rowin EJ; Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA.; Maron MS; Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA.
Source
Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0207277 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1913 (Electronic) Linking ISSN: 00029149 NLM ISO Abbreviation: Am J Cardiol Subsets: MEDLINE
Subject
Language
English
Abstract
Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on >50 years experience, surgery reliably reverses disabling heart failure by permanently abolishing mechanical outflow impedance and mitral regurgitation, with normalization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increasing significantly in number over the most recent 15 years. Performed in experienced multidisciplinary institutions, perioperative mortality for myectomy has declined to 0.6%, becoming one of the safest currently performed open-heart procedures. Extended myectomy relieves symptoms in >90% of patients by ≥ 1 NYHA functional class, returning most to normal daily activity, and also with a long-term survival benefit; concomitant Cox-Maze procedure can reduce the number of atrial fibrillation episodes. Surgery, preferably performed in high volume clinical environments, continues to flourish as a guideline-based and preferred high benefit: low treatment risk option for adults and children with drug refractory disabling symptoms from obstruction, despite prior challenges: higher operative mortality/skepticism in 1960s/1970s; dual-chamber pacing in 1990s, alcohol ablation in 2000s, and now introduction of novel negative inotropic drugs potentially useful for symptom management.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)