Register
Forgot your password?

Meta-analysis of results the surgical treatmenthypertrophic obstructive cardiomyopathy

Authors: M.E. Khitrova 1, L.A. Bockeria 1, M.I. Berseneva 1, S.L. Plavinskiy 2, M.V. Avdeeva 2

Company: 1 Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
 2 North-Western State Medical University named after I.I. Mechnikov of Ministry of Health of the Russian Federation, ulitsa Kirochnaya, 41, Saint-Petersburg, 191015, Russian Federation

For correspondence:  Sign in or register.


DOI: https://doi.org/10.24022/1997-3187-2017-11-4-337-347

For citation: Khitrova M.E., Bockeria L.A., Berseneva M.I., Plavinskiy S.L., Avdeeva M.V. Meta-analysis of results the surgical treatment hypertrophic obstructive cardiomyopathy. Kreativnaya Kardiologiya (Creative Cardiology). 2017; 11 (4): 337–47 (in Russ.). DOI: 10.24022/1997-3187-2017-11-4-337-347

Received / Accepted:  14.09.2017/10.10.2017

Keywords: hypertrophic obstructive cardiomyopathy myectomy surgical treatment meta-analysis

Download
Full text:  

 

Abstract

Objective. Comparative assessment of the immediate and remote risk of adverse outcomes of various methods of surgical treatment of hypertrophic obstructive cardiomyopathy based on the results of the meta-analysis.

Material and methods. Of the 214 literary sources found on the topic of interest, 72 studies were selected for the meta-analysis with a total of 7235 patients. Depending on the type of operational techniques, all studies were differentiated into 10 groups, including Morrow myectomy (group 1); expanded myectomy (group 2); the technique Resection, Plication and Release (group 3); myectomy and mitral valve plastic (group 4); myectomy with mitral valve replacement (group 5); myectomy with impact on papillary muscles (group 6); myectomy with combined procedures (group 7); transmitral myectomy (group 8); isolated mitral valve replacement (group 9); myectomy from the right ventricle (group 10).

Results. The highest relative risk (RR) of hospital death was observed in the group of patients who underwent an isolated prosthetic repair of the mitral valve (RR=0,0704; 95% CI 0,0404–0,12). A more significant risk of mortality at one year after surgery was observed in the group of patients with myectomy and mitral valve replacement (RR=0,1133; 95% CI 0,0669–0,1855). Accordingly, at 5 and 10 years after surgery, a more significant risk of death is noted in the myectomy group with combined procedures (RR=0,207; 95% CI 0,1038–0,3703 and RR=0,3238; 95% CI 0,1823–0,5071). The most favorable long-term results of surgical treatment were observed after the using of the technique Resection, Plication and Release (RR=0,0854; 95% CI 0,0412–0,1684).

Conclusion. After 5 and 10 years after surgical intervention, the most unfavorable outcomes of surgical treatment of hypertrophic obstructive cardiomyopathy are noted in the group of patients who underwent myectomy with combined procedures and groups with mitral valve replacement; the most favorable – with the use of the technique of Resection, Plication and Release.

References

  1. Matsushita T., Kawase T., Tsuda E., Kawazoe K. Apicoaortic conduit for the dilated phase of hypertrophic obstructive cardiomyopathy as an alternative alternative to heart transplantation. Interact. Cardiovasc. Thorac. Surg. 2009; 8 (2): 232–4.

  2. Brown M.L., Schaff H.V., Dearani J.A., Li Z., Nishimura R.A., Ommen S.R. Relationship between left ventricular mass, wall thickness, and survival after subaortic septal myectomy for hypertrophic obstructive cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2011; 141 (2): 439–43.

  3. Maron B.J., Maron M.S. A discussion of contemporary nomenclature, diagnosis, imaging, and management of patients with hypertrophic cardiomyopathy. Am. J. Cardiol. 2016; 118 (12): 1897–907.

  4. Boсkeria L.A., Boсkeria O.L., Klimchuk I.Ya.,Sanakoev M.K. Surgical correction of obstructivehypertrophic cardiomyopathy with SAM-syn-drome and atrial fibrillation. Annaly Aritmologii(Annals of Arrhythmology). 2016; 13 (4): 216–21.DOI:10.15275/annaritmol.2016.4.4 (in Russ.).

  5. Boсkeria L.A. Hypertrophic obstructive cardiomy-opathy. Annals of Surgery (Annaly Khirurgii). 2013;5: 5–14 (in Russ.).

  6. Castedo E., Cabo R.A., Núñez I., Monguió E., Montero C.G., Burgos R. et al. Surgical treatment for hypertrophic obstructive cardiomyopathy. Rev. Esp. Cardiol. 2004; 57 (8): 751–6.

  7. Wu J.J., Seco M., Medi C., Semsarian C., Richmond D.R., Dearani J.A. et al. Surgery for hypertrophic cardiomyopathy. Biophys. Rev. 2015; 7 (1): 117–25.

  8. Database of publicly and privately supported clinical studies of human participants conducted around the world. https://clinicaltrials.gov/ct2/ results/map?term=hypertrophic+cardiomyopathy&age=012 (дата обращения 16.06.2017).

  9. Bogachev-Prokof’ev A.V., Zheleznev S.M.,Fomenko M.S., Afanas’ev A.V., Sharifulin R.M.,Pivkin A.N. et al. Application extanded myectomyin surgical treatment obstructive hypertrophic car-diomyopathy: immediate results. PatologiyaKrovoobrashcheniya i Kardiokhirurgiya (CirculationPathology and Cardiac Surgery). 2015; 19 (2): 20–5(in Russ.)..

  10. Bogachev-Prokof’ev A.V., Zheleznev S.I.,Fomenko M.S., Afanas’ev A.V., Sharifulin R.M.,Nazarov V.M. et al. Mitral valve replacement orrepair: choosing optimal surgical treatment ofhypertrophic obstructive cardiomyopathy. Patolo-giya Krovoobrashcheniya i Kardiokhirurgiya (Circu-lation Pathology and Cardiac Surgery). 2015; 19 (4):26–33 (in Russ.).

  11. McIntosh C.L., Greenberg G.J., Maron B.J., Leon M.B., Cannon R.O. et al. Clinical and hemodynamic results after mitral valve replacement in patients with obstructive hypertrophic cardiomyopathy. Ann. Thorac. Surg. 1989; 47 (2): 236–46.

  12. Walker W.S., Reid K.G., Cameron E.W., Walbaum P.R., Kitchin A.H. Comparison of ventricular septal surgery and mitral valve replacement for hypertrophic obstructive cardiomyopathy. Ann. Thorac. Surg. 1989; 48 (4): 528–34.

  13. Krajcer Z., Leachman R.D., Cooley D.A., Coronado R. Septal myotomy-myomectomy versus mitral valve replacement in hypertrophic cardiomyopathy. Ten-year follow-up in 185 patients. Circulation. 1989; 80 (3 Pt 1): 57–64.

  14. Klues H.G., Roberts W.C., Maron B.J. Anomalous insertion of papillary muscle directly into anterior mitral leaflet in hypertrophic cardiomyopathy. Significance in producing left ventricular outflow obstruction. Circulation. 1991; 84 (3): 1188–97.

  15. Fomenko M.S. Surgical treatment of obstructivehypertrophic cardiomyopathy with mitral insuffi-ciency: Med. Sc. Diss. Author’s abstract.Novosibirsk; 2016 (in Russ.).

  16. Kaple R.K., Murphy R.T., DiPaola L.M., Houghtaling P.L., Lever H.M. et al. Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes. Ann. Thorac. Surg. 2008; 85 (5): 1527–35.

  17. Kutsurov D.D., Bockeria L.A., Khitrova M.E.,Kosareva T.I., Soboleva A.A., Malenkova D.A.Surgical correction of obstructive hypertrophiccardiomyopathy by access from the right ventricle.Byuletten’ Nauchnogo Tsentra Serdechno-SosudistoyKhirurgii imeni A.N. Bakuleva RAMN (The Bulletinof Bakoulev Center “Cardiovascular Diseases”).2015; 16 (S3): 96 (in Russ.).

About Authors

  • Khitrova Marina Erkinovna, Researcher, orcid.org/0000-0003-2209-1890;
  • Bockeria Leo Antonovich, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, Director, orcid.org/0000-0002-6180-2619;
  • Berseneva Marina Ivanova, Cand. Med. Sc., Deputy Head of Department; Plavinskiy Svyatoslav Leonidovich, Dr Med. Sc., Chief of Chair;
  • Avdeeva Marina Vladimirovna, Dr Med. Sc., Associate Professor, orcid.org/0000-0002-4334-5434.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by