Meta-analysis of Results of Hypertrophic Obstructive Cardiomyopathy Surgical Treatment

Marina Khitrova ¹, Leo A. Bokeria  ², Lyudmila A. Glushko  ², Marina I. Berseneva ², Svyatoslav L. Plavinskij ³, Marina V. Avdeeva ³, Magomed A. Abdurazakov ²

¹ Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia; ² Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia; ³ Federal State Budgetary Educational Institution for Higher Training «North-Western State Medical University named after I.I. Mechnikov» of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia;

Date, time and location: 2018.05.26 17:00, Press Hall, 2F

Abstract

Objective.The present study aimed to evaluate clinical safety of various methods of surgical treatment of hypertrophic obstructive cardiomyopathy (HOMC) based on an updated meta-analysis.

Material and methods. A systematic search of published literature in English and Russian was performed or studies with at least 10 patients withHOMC who had been performed a myectomy with/without reconstruction of the mitral valve (minimum follow up was 0.5 years).

Results. In HOMC wefound 72 studies with a total of 7235 patients and mean follow up of 5,2 years. All studies are divided into 10 groups depending on the type of surgical techniques: Morrow myectomy(group 1), expanded myectomy (group 2), the technique «Resection, Plication and Release» (group 3), myectomy and mitral valve repair (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).

The highest relative risk (RR) of hospital death is observed in the group 9, RR=0,07 (95% confidence interval [CI] 0,04 – 0,12). A more significant risk of mortality at one year after surgery is observed in the group 5, RR=0,11 (95% CI 0,06 – 0,18) and a more significant risk of death is noted in group 7, RR=0,2 (95% CI 0,01 – 0,37) and RR=0,32 (95% CI 0,18 – 0,5)at 5 and 10 years after surgery accordingly. The most favorable long-term results of surgical treatment were observed in group 3,RR=0,08 (95% CI 0,04 – 0,16).

Conclusion. After 5 and 10 years after surgical intervention, the most unfavorable outcomes of surgical treatment of HOMC are noted in group 7 -myectomy with combined procedures.