Consequences of impressive myectomy results in a Center of Excellence: The paradox of evidence-based medicine era
Abstract
Two thirds of patients with hypertrophic obstructive cardiomyopathy (HOCM) suffer from left ventricular obstruction at rest and/or during exercise. These patients have a higher risk of heart failure and sudden cardiac death.
Therefore, for symptomatic HOCM patients, a septal reduction therapy (surgical septal myectomy or alcohol septal ablation) is considered. In this issue of the American Heart Journal, the authors from the Mayo Clinic led by Dr Geske published an interesting long-term observation of HOCM patients treated with septal myectomy in their center between 2011 and 2014.
The aim of the study was to report the outcome of septal myectomy in symptomatic HOCM patients at tertiary referral center and to evaluate if a risk score for these patients can be calculated by using the Society of Thoracic Surgeons Adult Cardiac Surgery Risk Calculator (STS Calculator) for outcomes of mitral valve repair and aortic valve replacement. The authors analyzed the outcomes of 298 carefully selected HOCM patients from a total of 676 septal myectomies performed at the Mayo Clinic and compared the observed results with a STS risk score for mitral valve repair and aortic valve replacement.
They concluded there were no differences between observed mortality rates in patients undergoing septal myectomy and STS Calculator predicted risk for mitral valve repair and aortic valve replacement. Additionally, according to analyzed data, there was an impressive 0% early postmyectomy mortality rate and a 6-year survival rate of 98.7%.