Shift in the spectrum of patients with hypertrophic cardiomyopathy (HCM) referred to surgery in times of alcohol septal ablation (ASA)

Objective: Since the introduction of ASA into the therapy of HCM a significant shift in the spectrum and extent of the disease in patients (pts) referred to surgery has been observed.

Methods: We report the mid-term results of a consecutive series of 139 (age at operation 55±14 (range 11–77) years, 60% male) pts who underwent septal myectomy and additional procedures 2001–2005.

Results: Indications were asymmetric septum hypertrophy (ASH) in 92%, failed ASA in 10%, restenosis after myectomy in 2%, fibrotic stenosis of the left ventricular outflow tract in15%, ASH plus mitral regurgitation in 11%, ASH plus aberrant papillary muscle in 8%, bi- or midventricular stenosis in 8%, ASH plus CAD in 16% and ASH plus aortic valve disease in 7%.

Procedures included septal myectomy in 129 pts, mitral valve repair/replacement in 15%, aortic valve replacement in 7%, right- or midventricular myectomies in 8%, CABG in 31%, ICD implantation in 28% and atrial ablation in 2%. Other procedures were performed in 8%. 1 pt (0.8%) died early, 3 (2.4%) in the follow-up period.

Conclusions: Pts referred to surgery today have more complex disease than reported in the literature, often including ASH with fibrotic elements, mitral- or aortic valve involvement or atypical HCM as well as CAD. Isolated septal myectomy was performed in only 31% of pts, most of them not suited for ASA. This underscores the important role that surgery has to play today in the treatment of HCM.