Collis, Richard;
(2023)
Surgical management of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Introduction Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac condition affecting 1 in 500 of the population with a largely genetic autosomal dominant pattern of inheritance. Left ventricular outflow tract obstruction (LVOTO) is the most common clinical feature occurring in up to two thirds of patients with HCM leading to clinical symptoms and premature death. Different management strategies exist for LVOTO including pharmacological and invasive interventional techniques. Objectives The main aim of this thesis is to examine and evaluate current clinical practices and outcomes using varying surgical techniques in the management of LVOTO in HCM. Methods A systematic review of the literature and meta-analysis were performed in accordance with the PRISMA statement. Individual observational studies were also performed comprising of various surgical populations using a large relational database of patients with HCM in a single specialist cardiomyopathy clinic located in London, UK. Results Meta-analysis: Contemporary early (<30 days) and late (>30 days) mortality following septal myectomy were 1.4% (CI 0.8, 2.4) I2 9.0%, p = 0.36 and 0.7% (CI 0.3, 1.2) I2 70.7%, p < 0.05 respectively. Observational Study: Three hundred and forty seven patients underwent surgical intervention for LVOTO (1988-2015). Median follow-up was 5.2 years (interquartile range 1.9-7.9). The mean resting LVOT gradient improved post-operatively from 71.9 ± 39.6 mmHg to 13.4 ± 18.5 mmHg (P < 0.05). Overall, 72.4% of patients improved by >1 New York Heart Association (NYHA) class. There were 5 perioperative deaths and 20 late deaths (>30 days). 58.9% of patients undergoing mitral valve replacement alone did not improve their NYHA class. Long-term (>30 days) complications included atrial fibrillation (29.6%), transient ischaemic attack/stroke (2.4%) and heart failure hospitalisation (3.2%). There were 16 repeat surgical interventions at 3.0 years. Conclusions Septal myectomy is a safe procedure resulting in symptomatic improvement in the majority of patients. Ongoing clinical follow-up, surveillance and medical therapy is recommended after surgery.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Surgical management of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL 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 Population Health Sciences > Institute of Cardiovascular Science |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10165529 |
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