Working with Dr. Wu and intermittently Dr. Martinez, I have been doing a retroactive study on the success and effectiveness of septal myectomy for high risk/elderly patients expressing hypertrophic obstructive cardiomyopathy (HOCM). I have spent time learning a great deal about this disease, meeting with patients pre and post surgery in the office with Dr. Martinez, as well as observing the surgical procedures preformed by Dr. Wu. My main role in this project was to gather the data for the cohort of 20 patients and then to perform an analysis of the data to help draw conclusions. Through analysis of this data I found that LVHN has a unique population receiving septal myectomy procedures. Every 1 in 500 people has hypertrophic cardiomyopathy (HCM), but only approximately 25% of those people have obstruction. Of this smaller population, most patients have a septal myectomy done at an average age of 50 years, but at LVHN we have a cohort with an average age of 70.6. The objective behind the analysis was to evaluate whether conducting a septal myectomy at an older age is effective for patient health and relief of symptoms.
After looking at the data it was clear that elderly patients presenting obstructive HCM were very sick in a variety of ways. Approximately 60% of patients presented multiple symptoms prior to surgery, which we were looking to relieve. HCM is a genetic disorder, so all acquired family history was observed and it was found that there was significant family history of coronary artery disease, hypertension and HCM in multiple patients. Each patient’s previous and current medical histories were also analyzed. Every patient had an extensive medical history aside from HCM, which we found to result in concomitant procedures in 75% of patients during their surgeries. Concomitant procedures during surgery included aortic valve replacements (AVR), mitral valve repair/replacement, and coronary artery bypass grafting (CABG).
Numerical findings during the surgery were also analyzed including left ventricular outflow tract (LVOT) gradients, septal wall thickness and mass removed. There were significant decreases in LVOT gradients, from a medican of 68 mmHg pre surgery to 9 mmHg post surgery. Initial wall thickness was on average 2.29 cm (with 1.5 cm being the maximum thickness for normal heart walls) and the average mass removed was approximately 5 grams. Length of stay post surgery was found to be an average of 5 days, with only three patients being readmitted. Because of the high frequency of heart block and atrial fibrillation involved in this type of surgery, 40% of patients did require a permanent pacemaker following surgery.
It was concluded that for elderly patients with obstructive HCM, septal myectomy should be the treatment of choice. It is safe and reliable in reducing symptoms, eliminating LVOTO and reducing systolic anterior motion of the mitral valve. Even with concomitant procedures our patients did well post surgery.
Published In/Presented At
Geist, H., & Wi, J. (2013, July 26). Septal Myectomy in Obstructive HCM High Risk Patients. Poster presented at: Research Day 2013, Lehigh Valley Health Network, Allentown, PA.
Department of Surgery, Research Scholars, Research Scholars - Posters, USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
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