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Outcomes following the surgical management of left ventricular outflow tract obstruction; A systematic review and meta-analysis

Collis, RA; Rahman, MS; Watkinson, O; Guttmann, OP; O'Mahony, C; Elliott, PM; (2018) Outcomes following the surgical management of left ventricular outflow tract obstruction; A systematic review and meta-analysis. International Journal of Cardiology , 265 pp. 62-70. 10.1016/j.ijcard.2018.01.130. Green open access

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Abstract

BACKGROUND: Left ventricular outflow tract obstruction (LVOTO) causes exertional symptoms in two thirds of patients with hypertrophic cardiomyopathy (HCM). Consensus guidelines recommend surgical intervention in patients with drug refractory symptoms. The primary aim of this study was to perform a systematic review and meta-analysis to determine morbidity and mortality after surgery. METHODS: Study Selection: Studies reporting outcomes following surgical intervention for symptomatic LVOTO in HCM. RESULTS: 85 studies were included in the systematic review and 35 studies in the meta-analysis. Contemporary early (<30 days) and late (>30 days) mortality following septal myectomy were 1.4% (CI 0.8, 2.4) I^{2} 9.0%, p = 0.36 and 0.7% (CI 0.3, 1.2) I^{2} 70.7%, p < 0.05 respectively. Sixty-eight studies (80%) reported perioperative complications. The contemporary rate of a perioperative ventricular septal defect was 1.4% (0.8, 2.3) I^{2} 0%, p < 0.05. Late morbidities including atrial fibrillation, stroke, heart failure and transplant were reported in fewer than 22% of studies and few studies compared mortality and clinical outcomes using different surgical approaches to LVOTO. The incidence rate (IR) of reintervention with a further surgical procedure was 0.3% (CI 0.2, 0.4) I^{2} 52.5%, p < 0.05. CONCLUSIONS: Contemporary surgical management of LVOTO is associated with low operative mortality rates but further studies are needed to investigate the impact of surgical therapy on non-fatal early and late complications.

Type: Article
Title: Outcomes following the surgical management of left ventricular outflow tract obstruction; A systematic review and meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijcard.2018.01.130
Publisher version: https://doi.org/10.1016/j.ijcard.2018.01.130
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Septal Myectomy, Mitral valve, Left ventricular outflow tract obstruction, Hypertrophic cardiomyopathy
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10052163
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