Recent Trends and Outcomes of Concomitant Mitral Valve Replacement and Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: Insights from the National Inpatient Sample 2016-2020

Document Type

Article

Abstract

Background: Surgical myectomy (SM) is the definitive treatment for symptomatic drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). Isolated SM is effective in majority with minority requiring additional mitral valve repair (MVRr). Mitral valve replacement (MVRt) is largely avoided due to long-term complications of prosthetic valves. We aimed to examine temporal trends, clinical profile and outcomes of concomitant SM+MVRt in comparison to SM±MVRr.

Methods: National Inpatient Sample was queried to identify adults with HCM and SM subgroups. In-hospital outcomes were compared with use of logistic regression.

Results: From 2016-2020, 5885 patients underwent SM, of whom 885 (15%) had concomitant MVRt. Compared to SM±MVRr (Table), those with SM+MVRt were older, more often female, and had higher comorbidity as assessed by Charlson comorbidity index. SM+MVRt was more commonly performed in Midwest and Southern US and was associated with higherregional mortality rates (particularly in those with comorbidities), higher rates of complete heart block, cardiogenic shock, and acute kidney injury. Hospital length of stay and total hospital costs were higher inthose with SM+MVRt.

Conclusion: Geographic differences were noted in rates of MVRt and MVRr at time of SM in HOCM. Some baseline differences existed between two groups and significantly higher rates of adverse outcomes, including hospital mortality, were observed in those with MVRt.

First Page

594

DOI

10.1016/S0735-1097(24)02584-1

Publication Date

4-2-2024

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