|
|
| Line 1: |
Line 1: |
| {{SI}}
| | #REDIRECT [[Hypertrophic cardiomyopathy septal myectomy]] |
| {{CMG}}
| |
| | |
| ==Overview==
| |
| | |
| '''Septal myectomy''' is a [[cardiac surgery|surgical]] treatment for [[hypertrophic cardiomyopathy]] (HCM). Septal myectomies have been successfully performed for more than 25 years.
| |
| | |
| ==Outcomes==
| |
| Septal myectomy is associated with a low perioperative mortality and a high late survival rate. A study at the [[Mayo Clinic]] found surgical myectomy performed to relieve outflow obstruction and severe symptoms in HCM was associated with long-term survival equivalent to that of the general population, and superior to obstructive HCM without operation. The results are shown below:<ref name="Ommen 2005">{{cite journal | author = Ommen S, Maron B, Olivotto I, Maron M, Cecchi F, Betocchi S, Gersh B, Ackerman M, McCully R, Dearani J, Schaff H, Danielson G, Tajik A, Nishimura R | title = Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy | journal = J Am Coll Cardiol | volume = 46 | issue = 3 | pages = 470-6 | year = 2005 | id = PMID 16053960}}</ref>
| |
| | |
| <center>
| |
| {| border="0"
| |
| |
| |
| {| class="wikitable"
| |
| |+ Survival (all-cause mortality) *
| |
| |-
| |
| ! Years
| |
| ! With surgery
| |
| ! Without surgery
| |
| |-
| |
| | 1
| |
| | 98%
| |
| | 90%
| |
| |-
| |
| | 5
| |
| | 96%
| |
| | 79%
| |
| |-
| |
| | 10
| |
| | 83%
| |
| | 61%
| |
| |}
| |
| |
| |
| {| class="wikitable"
| |
| |+ Survival (HCM-related death)
| |
| |-
| |
| ! Years
| |
| ! With surgery
| |
| ! Without surgery
| |
| |-
| |
| | 1
| |
| | 99%
| |
| | 94%
| |
| |-
| |
| | 5
| |
| | 98%
| |
| | 89%
| |
| |-
| |
| | 10
| |
| | 95%
| |
| | 73%
| |
| |}
| |
| |
| |
| {| class="wikitable"
| |
| |+ Survival (sudden cardiac death)
| |
| |-
| |
| ! Years
| |
| ! With surgery
| |
| ! Without surgery
| |
| |-
| |
| | 1
| |
| | 100%
| |
| | 97%
| |
| |-
| |
| | 5
| |
| | 99%
| |
| | 93%
| |
| |-
| |
| | 10
| |
| | 99%
| |
| | 89%
| |
| |}
| |
| |}
| |
| <nowiki>*</nowiki> Includes 0.8% operative mortality.
| |
| </center>
| |
| | |
| ==Comparison with alcohol ablation==
| |
| | |
| Either [[alcohol septal ablation]] or myectomy offers substantial clinical improvement for patients with [[hypertrophic obstructive cardiomyopathy]].
| |
| | |
| Hemodynamic resolution of the obstruction and its sequelae is more complete with myectomy.<ref name="Ralph-Edwards 2005">{{cite journal | author = Ralph-Edwards A, Woo A, McCrindle B, Shapero J, Schwartz L, Rakowski H, Wigle E, Williams W | title = Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score | journal = J Thorac Cardiovasc Surg | volume = 129 | issue = 2 | pages = 351-8 | year = 2005 | id = PMID 15678046}}</ref>
| |
| | |
| ==2011 ACCF/AHA Guideline Recommendations: Septal Myectomy <ref name="pmid22075468">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=2703–38 |year=2011 |month=December |pmid=22075468 |doi=10.1016/j.jacc.2011.10.825 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)04383-X |accessdate=2011-12-19}}</ref><ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>==
| |
| | |
| {{cquote|
| |
| | |
| ====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
| |
| | |
| '''1.''' Consultation with centers experienced in performing both surgical [[septal myectomy]] and alcohol septal ablation is reasonable when discussing treatment options for eligible patients with HCM with severe drug-refractory symptoms and LVOT obstruction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
| |
| | |
| '''2.''' [[septal myectomy|Surgical septal myectomy]], when performed in experienced centers, can be beneficial and is the first consideration for the majority of eligible patients with [[HCM]] with severe [[Hypertrophic cardiomyopathy medical treatment|drug-refractory symptoms]] and LVOT obstruction.(61,62,155,273–275) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
| |
| | |
| '''3.''' [[septal myectomy|Surgical septal myectomy]], when performed at experienced
| |
| centers, can be beneficial in symptomatic children with [[HCM]] and severe resting obstruction (>50 mm Hg) for whom standard medical therapy has failed.(276) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
| |
| | |
| ==Guideline Resources==
| |
| *[http://content.onlinejacc.org/cgi/reprint/58/25/e212.pdf 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy] <ref name="pmid22075468">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=2703–38 |year=2011 |month=December |pmid=22075468 |doi=10.1016/j.jacc.2011.10.825 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)04383-X |accessdate=2011-12-19}}</ref><ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>
| |
| | |
| ==Related Chapters==
| |
| * [[Hypertrophic cardiomyopathy interventional cardiology|Hypertrophic cardiomyopathy]]
| |
| * [[Alcohol septal ablation]]
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
| | |
| {{SIB}}
| |
| | |
| {{cardiac surgery}}
| |
| | |
| [[Category:Cardiac Surgery]]
| |
| [[Category:Cardiology]]
| |
| | |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |