Brief reportSeptal Myectomy and Concomitant Coronary Artery Bypass Grafting for Patients With Hypertrophic Cardiomyopathy and Coronary Artery Disease
Section snippets
Patients and Methods
This study was approved by the Mayo Clinic Institutional Review Board (IRB# 18-008785). Between January 1, 1961, and October 31, 2017, 2913 adult patients with obstructive HCM as defined by American Heart Association guidelines underwent transaortic septal myectomy at our clinic. Concomitant CABG was performed in 246 (8.4%). We compared baseline characteristics of patients who underwent septal myectomy with and without CABG and assessed the effect of surgical revascularization on the risk of
Results
Patients who underwent concomitant CABG were older (median [interquartile range], 66.3 [59.8-72.1] years vs 54.4 [43.5-64.8] years; P<.0001) and more likely to be male (63.0% vs 54.2%; P=.008) than those who did not undergo coronary revascularization at operation (Table 1). Patients who underwent concomitant CABG more often had a history of diabetes (17.1% vs 9.1%; P<.0001), systemic hypertension (76.8% vs 47.4%; P<.0001), and hyperlipidemia (81.7% vs 59.4%; P<.0001). The body mass index
Discussion
In the present series of a large population who underwent septal myectomy for obstructive HCM, coronary artery disease managed by concomitant CABG was an important factor associated with mortality. Similarly, Woo et al3 reported that need for coronary revascularization was an independent predictor of death in 338 patients with HCM who underwent septal myectomy. Wang et al4 described an increased rate of cardiovascular events in 44 patients with obstructive HCM who underwent myectomy with CABG
Conclusion
Obstructive coronary artery disease severe enough to prompt concomitant CABG at the time of septal myectomy is an important risk factor for late mortality. Although surgical revascularization at the time of myectomy is safe, the risk of death remains elevated in patients with coronary artery disease undergoing concomitant CABG.
References (5)
- et al.
Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease
Circulation
(2003) - et al.
Survival differences in women and men after septal myectomy for obstructive hypertrophic cardiomyopathy
JAMA Cardiol
(2019)
Cited by (3)
Septal Myectomy: An Evolving Therapy for Obstructive Hypertrophic Cardiomyopathy
2023, Journal of the American College of Cardiology
Grant Support: The work was supported by the Paul and Ruby Tsai Family.
Potential Competing Interests: The authors report no competing interests.