Surgical treatment of hypertrophic obstructive cardiomyopathy in relatively elderly patients: Short- and long-term outcomes. (12th April 2022)

• Record Type: Journal Article
• Authors: Lapenna, Elisabetta; Nisi, Teodora; Carino, Davide; Del Forno, Benedetto; Ruggeri, Stefania; Schiavi, Davide; Meneghin, Roberta; Macrì Demartino, Roberto; Castiglioni, Alessandro; Maisano, Francesco; Alfieri, Ottavio; De Bonis, Michele
• Is Part Of: European journal of cardio-thoracic surgery. Volume 62:Number 5(2022)
• Publication Date: 2022-04-12
• Subjects: hypertrophic obstructive cardiomyopathy -- elderly -- surgical treatment; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac229
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Our goal was to assess the short- and long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy in patients ≥65 years of age compared to patients < 65 years of age. METHODS: Sixty-four patients aged ≥65 years, surgically treated for symptomatic hypertrophic obstructive cardiomyopathy, were compared to a control group of 125 patients <65 years. RESULTS: Patients aged ≥65 years were less frequently male (36% vs 68%, P < 0.001) and had higher EuroSCORE II scores [1.4 (1.1–2.2) vs 0.8 (0.7–1.2), P < 0.001], lower risk of sudden death, higher pulmonary artery pressure [40 (30–50) vs 30 (30–43), P = 0.04) and more mitral annulus calcifications (44% vs 14%, P < 0.001) compared to younger patients. Hospital death was 1%, with no difference between the 2 groups (1.5% vs 0.8%, P = 0.9). Patients aged ≥65 years had more concomitant coronary bypass grafting (12% vs 5%, P = 0.05) and a higher incidence of blood transfusions (50% vs 17%, P < 0.001) and postoperative atrial fibrillation (19% vs 8%, P = 0.02). Follow-up was 98% complete [median 8.3 (5.3–12.8) years]. The 13-year survival in the group aged ≥65 was 54 (SD: 9) % vs 83 (SD: 5) % in the control group ( P < 0.001), but it was comparable to that expected in the age-sex matched general national population. At 13 years, the cumulative incidence function of cardiac death in the elderly group was 19 (SD: 7)%, mostly unrelated to hypertrophic cardiomyopathy causes. At the last follow-up, 90% of patients were in New York Heart Association functional class I-II and 68% were in sinus rhythm. CONCLUSIONS: Selected elderly symptomatic patients with hypertrophic obstructive cardiomyopathy can benefit from surgery, with low hospital mortality and morbidity, relief of symptoms and late survival comparable to that expected in the age-sex matched general population. Abstract : Surgery is the gold standard for the treatment of severe symptomatic refractory hypertrophic obstructive cardiomyopathy (HOCM) because it relieves symptoms related to left ventricular outflow tract (LVOT) obstruction and affects quality of life and survival at the long-term follow-up [1].