Late Health Status of Patients Undergoing Myectomy for Obstructive Hypertrophic Cardiomyopathy

Abstract

Surgical myectomy eliminates symptoms in most patients with obstructive hypertrophic cardiomyopathy, but dyspnea and/or angina can recur in some. This study investigated clinical features associated with a lack of clinical improvement postoperatively. Between March 2007 and December 2012, 963 patients underwent transaortic septal myectomy at our clinic. Six hundred one patients received standardized follow-up questionnaires, which were answered by 409 (68.1%). We compared clinical characteristics of patients with and without improvement and identified predictors of worsening health using a multivariable proportional odds ordinal logistic model. Of 409 patients, 329 (80.4%) indicated better health status at follow-up and 80 (19.6%) responded that their health had stayed the same or worsened. The median age of patients with perceived better health was 56.8 years (interquartile range, 47.4, 65.7) and those without improvement was 63.0 years (interquartile range, 50.0, 70.2). New York Heart Association class III/IV dyspnea was present in 90.3% of patients who reported improvement and in 79.7% who did not. In multivariable analysis the presence of coronary artery disease (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.17-6.50; P= .020), lower preoperative left ventricular ejection fraction (per interquartile range increase: OR, 0.76; 95% CI, 0.57-0.99; P= .047), and worse preoperative health status (eg, poor or fair: OR, 1.63; 95% CI, 1.05-2.54; P= 0.004) were associated with worse health status at follow-up. Septal myectomy leads to excellent symptomatic relief in most patients, and more than 80% report subjective improvement in health status. Important predictors of worsening health included coronary artery disease and poor preoperative health status.