Oberoi M, Schaff HV, Nishimura RA, Geske JB, Dearani JA, Ommen SR. Surgical Management of Hypertrophic Cardiomyopathy Complicated by Infective Endocarditis.
Ann Thorac Surg 2022;
114:744-749. [PMID:
35120877 DOI:
10.1016/j.athoracsur.2022.01.016]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND
Infective endocarditis (IE) is a serious complication in hypertrophic cardiomyopathy (HCM). Cardiac surgery is often necessary, however, literature assessing surgical outcomes is limited.
METHODS
From December 1995 to September 2018, 43 patients with a history of HCM and native valve IE underwent cardiac surgery at our institution. Relevant data were abstracted from medical records and analyzed.
RESULTS
Median age was 57 years (IQR 45-67), 81% (n=35) were male. IE was active in 21% (n=9) patients at the time of surgery; Of these, the suspected origin of infection was orodental in 19% (n=8) patients. Significant mitral valve regurgitation was detected in 54% (n=23) patients and aortic valve regurgitation in 7% (n=3). Septal myectomy (SM) was performed in 95% (n=41) patients, with concomitant valve surgery in 58% (n=25) including prosthetic replacement in 28% (n=12). Two patients underwent double valve replacement without SM. Outflow gradients improved from median 67mmHg (IQR 34-97 mmHg) to 9mmHg (IQR 6-22 mmHg). One in-hospital death occurred due to uncontrollable pulmonary edema. As of last follow up, seven patients required reoperation and the 5 and 10-year cumulative incidences were 11% and 26%. Ten deaths occurred and overall survival probability at 5 and 10-years was 94% and 78% respectively.
CONCLUSIONS
Valvular complications of IE add complexity to surgical management of HCM. There is an increased need for concomitant valve repairs, prosthetic replacements and reoperation. These data underscore the need for recognition of infection, especially after oral procedures, which preceded majority of the active IE cases.
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