Cirugía En La Miocardiopatía Hipertrófica Obstructiva. Resultados a 10 Años

Introduction: Obstructive hypertrophic myocardiopathy is an uncommon disease. Surgical treatment with septal myectomy in experienced centres improves clinical outcomes and survival. Septal myectomy and, occasionally, mitral valve replacement are the fundamental techniques. Methods: A retrospective analysis carried out on 30 patients with obstructive hypertrophic myocardiopathy operated in our centre (2007-2017). Results: The group variables were: age (mean) 67.3 +/- 12 years; 56.7% women: mean EuroSCORE-Logistic 6.3 +/- 4.4; interventricular septum 24.9 +/- 2.9 mm; moderate-severe septal anterior movement (43.4%): mitral regurgitation grade III (46.7%) and IV (33.3%): mitral disease (calcification, dysplasia, prolapse) in 17 (56.7%). The procedures performed were: septal myectomy (100%); coronary bypass in 8 (26.7%), and aortic valve replacement in 8 (26.7%). The 26.7% (8) that received mitral valve replacement was due to valvular disease and persistence of mitral regurgitation. This group had more severe mitral regurgitation and a significantly worse functional grade. There was one (3.3%) death due to pulmonary haemorrhage, and 2 (6.7%) patients were re-operated due to bleeding. The mean follow-up was 43.7 +/- 36.3 (median 30) months (maximum 116). The functional grade went from: IV (43.3%) and III (56.7%) presurgery to 11 (24.1%) and I (75.9%) post-surgery (P < .0001). The intraventricular gradient decreased from 106.1 +/- 27.5 mmHg (median 104.5) to 11.9 +/- 7.2 mmHg (median 10) (P < .0001). At 10 years, survival was 93.1%. It was 87.5% if they received a MVR and 95.2% without MVR (P= .49). Conclusions: Mitral valve degeneration often requires an implant, but with or without an mitral valve replacement, surgery in obstructive hypertrophic myocardiopathy offers good survival and long-term clinical improvement. (C) 2018 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.