Tiefe erweiterte Myektomie und Mobilisation des subvalvulären Mitralklappenapparates bei hypertropher obstruktiver Kardiomyopathie – Operative Ergebnisse und Risiken unter besonderer Berücksichtigung von Patienten mit vorheriger perkutaner transluminaler septaler Myokardablation

Deep extended myectomy and mobilization of the subvalvular mitral valve apparatus for hypertrophic obstructive cardiomyopathy - operative outcomes and risks with special reference to patients with prior percutaneous transluminal septal myocardial ablation

by Max Gleichauf
Doctoral thesis
Date of Examination:2021-10-26
Date of issue:2021-09-30
Advisor:Prof. Dr. Gerd Hasenfuß
Referee:Prof. Dr. Gerd Hasenfuß
Referee:Prof. Dr. Ingo Kutschka
Referee:Prof. Dr. Ralf Dressel
Persistent Address: http://dx.doi.org/10.53846/goediss-8850

 

 

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Abstract

English

Hypertrophic cardiomyopathy (HCM) is a global disease of the myocardium with an incidence of 1:200 to 1:500 in the population. Possible clinical manifestations include sudden cardiac death, heart failure, and atrial fibrillation. Combinations of these courses may occur. A subtype of HCM is hypertrophic obstructive cardiomyopathy (HOCM). This subtype affects 25-30% of patients with HCM and is characterized by a dynamic pressure gradient across the left ventricular outflow tract (LVOT) caused by, among other things, asymmetric hypertrophy of the intraventricular septum. Therapeutic approaches include surgical resection of the septal hypertrophy and catheter-based ablation (percutaneous transluminal septal myocardial ablation, PTSMA) by instillation of ethanol via a coronary artery branch. The aim of this study was to evaluate the operative outcomes and risks of deep extended myectomy with mobilization of the subvalvular mitral valve apparatus for HOCM and to identify whether subgroup differences existed for patients with prior PTSMA (n = 32/118). With regard to reduction in gradient across the LVOT and degree of mitral regurgitation as well as periprocedural mortality, the results of the present study suggest comparable efficacy and safety of deep extended myectomy with mobilization of the mitral valve apparatus for patients with and without prior PTSMA. An exception is the perioperative development of high-grade mitral regurgitation, for the development of which patients with prior PTSMA are at increased risk according to the data of the present study. Also, permanent atrioventricular block grade III and pacemaker rhythm occurred significantly more frequently in this patient population.
Keywords: hypertrophic; cardiomyopathy; surgery; HCM; HOCM; septal ablation; PTSMA
 
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