Concomitant septal myectomy in patients undergoing aortic valve replacement for severe aortic stenosis.

Lim, Ju Yong; Choi, Jin Oh; Oh, Jae Kon; Li, Zhou; Park, Soon J
Circulation journal : official journal of the Japanese Circulation Society
2015NA ; 79 ( 2 ) :375-80.
저자 상세정보
Lim, Ju Yong -
Choi, Jin Oh -
Oh, Jae Kon -
Li, Zhou -
Park, Soon J -
ABSTRACT
BACKGROUND: Patients with severe aortic stenosis (AS) are often found to have asymmetric septal hypertrophy (ASH). With low sensitivity of echocardiography for detecting dynamic left ventricular outflow tract (LVOT) obstruction in severe AS, we adopted a routine intraoperative inspection of LVOT strategy for aortic valve replacement (AVR), and performed concomitant septal myectomy (CSM) as necessary. We sought to (1) evaluate surgical outcomes of CSM, (2) suggest preoperative echocardiographic parameters that correlate with findings of ASH, and (3) determine the predictors of CSM. METHODS AND

RESULTS: A single surgeon performed AVR for moderate-to-severe AS in 301 patients from 2007 to 2012. CSM was performed in 35 (11.6%) patients, resulting in AVR vs. AVR+CSM groups. Echocardiographic parameters, including the ratio of LVOT to aortic annular diameter (LVOT/AA), were compared. Mortality rate was comparable between groups (P=0.37). There were no postoperative complications related to CSM. The AVR+CSM group had a smaller LVOT/AA ratio (P=0.0012). The predictor of CSM was implanted valve size ??21 mm (odds ratio 3.2, confidence interval 1.54-6.65, P=0.002).

CONCLUSIONS: CSM can be performed safely at the time of AVR. The preoperative echocardiographic LVOT/AA ratio may help in detecting ASH. As an implanted valve size ??21 mm was the only risk factor for CSM, careful assessment of LVOT is important in patients with a small aortic annulus.
Aortic valve replacement; Hypertrophic cardiomyopathy; Septal myectomy
MESH
Aged, Aged, 80 and over, *Aortic Valve/surgery/ultrasonography, *Aortic Valve Stenosis/surgery/ultrasonography, Echocardiography, Female, *Heart Septum/surgery/ultrasonography, *Heart Valve Prosthesis Implantation, Humans, Male, Middle Aged
링크

주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
CSM can be performed safely at the time of AVR.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
DOI
10.1253/circj.CJ-14-0672.
KCD코드
ICD 03
건강보험코드