Septal myectomy considered safe for older patients, reveals Study

"Septal myectomy is considered safe for older patients; however, the presence of left ventricular wall asymmetry is associated with a worse prognosis," the researchers wrote.

Recent studies have highlighted the unique clinical characteristics and postoperative outcomes of elderly patients undergoing septal myectomy for obstructive hypertrophic cardiomyopathy (oHCM). Understanding how oHCM manifests in older adults is critical for improving treatment strategies and outcomes as the population ages.

Surgical septal reduction is often deferred in older adults due to concerns about elevated operative risks. Considering this, Hartzell V. Schaff, Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA, and colleagues aimed to compare the clinical and echocardiographic features of young and older patients undergoing septal myectomy for oHCM and to evaluate differences in early and late postoperative outcomes.

For this purpose, the researchers included 2,663 patients with obstructive hypertrophic cardiomyopathy who underwent transaortic septal myectomy between 2000 and 2021. These patients were categorized by age into three groups: 18-64 years, 65-74 years, and 75 years and older.

The following were the key findings of the study:

• The median age at the time of surgery increased over the study period. Older patients had a higher prevalence of female sex, hypertension, and diabetes, while the extent of functional limitation, as measured by NYHA class, remained similar across age groups.
• Elderly patients exhibited thinner septal and posterior walls and less pronounced asymmetry, and they were less likely to test positive for genetic markers.
• Hospital mortality rates were 0.2%, 0.5%, and 1.3% for patients under 65, those aged 65-74, and those 75 and older, respectively.
• Five-year survival rates were 97%, 93%, and 91%.
• In patients over 65, the septal-to-posterior wall thickness ratio was significantly associated with increased mortality, whereas this correlation was not observed in younger patients.
• Most patients reported an improvement in quality of life following myectomy.

The findings revealed that the clinical characteristics of obstructive hypertrophic cardiomyopathy (oHCM) in older patients differ from those in younger individuals. The researchers observed that older patients exhibit more symmetric but less extensive ventricular hypertrophy and lower rates of positive genetic testing. This indicates that HCM may have distinct clinical and morphological variants in the elderly.

"While septal myectomy is considered safe for older patients, the presence of left ventricular wall asymmetry is associated with a poorer prognosis," they concluded.

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DOI: https://www.jtcvs.org/article/S0022-5223(24)00904-8/abstract