在对 HOCM 进行手术切除的同时进行二次脊髓切断术的临床效果。

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-10-04 DOI:10.1055/a-2434-7627
Tijn Julian Pieter Heeringa, Romy Rmjj Hegeman, Len van Houwelingen, Marieke Hoogerwerf, David Stecher, Johannes C Kelder, Pim van der Harst, Martin J Swaans, Mostafa M Mokhles, Ilonca Vaartjes, Patrick Klein, Niels P van der Kaaij
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引用次数: 0

摘要

目的:对于因肥厚型梗阻性心肌病(HOCM)而接受手术室间隔肌层切除术的患者,额外的二尖瓣修复术可能会在进一步降低左心室流出道(LVOT)梯度、收缩期前移(SAM)和二尖瓣反流(MR)方面带来额外的益处。我们对文献进行了系统性回顾,以评估在对 HOCM 患者进行手术髓腔切除术的同时进行二次弦切的证据:我们在 MEDLINE 和 EMBASE 中进行了系统性文献检索,直至 2024 年 4 月。研究的主要结果是术后超声心动图左心室出口梯度。对主要结果进行了随机效应均值荟萃分析。次要研究结果为术后残留 MR 级、30 天新永久起搏器植入和院内死亡率:在1911篇文章中,共有6篇符合纳入标准,包括471名患者,术前静息左心室梯度的平均值为84 mmHg (95% CI: 76-91)。术后汇总的 LVOT 梯度平均值为 11 mmHg(95% CI:10 - 12),异质性较低(I2 = 44%)。9例(1%)患者的左心室出口残余梯度超过30毫米汞柱。出院时出现 MR 3 级或 4 级的患者有 7 例(1%)。30天新永久起搏器植入率为7%,院内死亡率为0.4%:本系统综述和荟萃分析表明,在 HOCM 患者中,结合手术室间隔 myectomy 切除术和二次弦切可以安全有效地消除 LVOT 阻塞。还需要进一步研究,以确定额外的二次弦切手术的附加效果。
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Clinical Outcomes of Concomitant Secondary Chordal Cutting to Surgical Myectomy in HOCM.

Objectives: In patients who underwent surgical septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), additional mitral valve repair may offer additional benefits in terms of further reducing left ventricle outflow tract (LVOT) gradients, systolic anterior motion (SAM) and mitral regurgitation (MR). We performed a systematic review of the literature to evaluate the evidence of surgical myectomy with additional secondary chordal cutting in patients with HOCM.

Methods: A systematic literature search in MEDLINE and EMBASE was performed until April 2024. The primary outcome studied was postoperative echocardiographic LVOT-gradient. A random effects meta-analysis of means was performed for the primary outcome. The secondary outcomes studied were postoperative residual MR-grade, 30-day new permanent pacemaker implantation, and in-hospital mortality.

Results: From 1911 unique publications, a total of 6 articles fulfilled the inclusion criteria and comprised 471 patients with a pooled mean preoperative resting LVOT gradient of 84 mmHg (95% CI: 76-91). The postoperative pooled mean LVOT-gradient was 11 mmHg (95% CI: 10 - 12) with a low heterogeneity (I2 = 44%). The residual LVOT gradient exceeding 30 mmHg was present in 9 (1%) patients. MR-grade 3 or 4 at hospital discharge was present in 7 (1%) patients. The 30-day new permanent pacemaker implantation rate was 7% and the in-hospital mortality was 0.4%.

Conclusion: This systematic review and meta-analysis demonstrate that combining surgical septal myectomy with secondary chordal cutting can be performed safely and effectively eliminate LVOT obstruction in HOCM patients. Further studies are needed to determine the additive effectiveness of additional secondary chordal cuttings.

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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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