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The present study aims to investigate whether preoperative statin use is associated with less postoperative atrial fibrillation occurrence after septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). Clinical data of consecutive patients with HOCM who underwent septal myectomy between February 2009 and May 2019 at our institution was retrospectively reviewed. The cohort was divided into 2 groups according to the status of preoperative statin use (statin group vs no statin group). Logistic regression was used to explore associations of clinical variables with postoperative atrial fibrillation occurrence. A total of 1307 patients with HOCM underdoing septal myectomy were included in the present study, with 109 patients in the statin group and 1198 in the no statin group. Among 322 patients (24.6%) developing postoperative atrial fibrillation, 21 cases (19.3%) occurred in the statin group, while 301 cases (25.1%) were in the no statin group (P = 0.202). After propensity score matching with confounding variables at baseline, 91 paired patients were included in the matched cohort. Postoperative atrial fibrillation developed in 17 (18.7%) and 38 (41.8%) in the statin and no statin groups, respectively (P = 0.001). Preoperative statin use was associated with less postoperative atrial fibrillation occurrence (odds ratio 0.220, 95% confidence interval 0.083-0.588, P<0.003). The present study suggested that preoperative statin use was associated with less postoperative atrial fibrillation occurrence after septal myectomy in patients with HOCM. This finding may provide clues for subsequent prospective study to investigate this clinical issue. [ABSTRACT FROM AUTHOR]

Background: Myocardial bridging (MB) is commonly treated in patients with hypertrophic cardiomyopathy. However, whether and how MB should be treated in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remain unclear. Methods: A total of 823 adults with HOCM who underwent septal myectomy at the Fuwai Hospital from 2011 to 2017 were retrospectively studied. Results: Overall, 31 events occurred: 24 patients died and 7 had nonfatal myocardial infarction (MI). The 3‐year cumulative event‐free survival of all‐cause death (97.9% vs. 100% vs. 100% vs. 98.4%, p =.89) and cardiovascular death (98.3% vs. 100% vs. 100% vs. 98.4%, p =.63) were similar among the four groups (non‐MB, coronary artery bypass grafting [CABG], unroofing, untreated, respectively). However, the 3‐year cumulative event‐free survival of nonfatal MI (100% vs. 97.5% vs. 98.0% vs. 89.9%, p <.001) and combined endpoints (97.9% vs. 97.5% vs. 98.0% vs. 88.4%, p =.02) were significantly lowest in untreated MB (non‐MB, CABG, unroofing, untreated, respectively). Cox regression analysis indicated that untreated MB was a significant independent predictor of combined endpoints (hazard ratio: 4.06, 95% confidence interval: 1.60–10.32, p <.001). Moreover, 49 patients underwent coronary artery computed tomography 1 year after surgery. The patency rate of the saphenous vein graft was significantly higher than that of the left internal mammary artery (13.3% vs. 84.2%, p <.001). No MB was detected in the unroofing group. Conclusions: Surgical MB treatment could be beneficial and performed safely during septal myectomy. Myocardial unroofing is the recommended treatment for MB, and unroofing when technically possible may be preferable for long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background: The mid-term outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing coronary artery bypass graft (CABG) is unclear.Materials and Methods: We studied 44 patients with HOCM and coronary artery disease (CAD) who underwent septal myectomy and CABG) between 2011 and 2017. The control group was matched in a ratio of 4:1 based on age, sex, body mass index, hypertension, and chest pain.Results: Compared to patients without CAD, patients with CAD had a higher long-term cardiovascular mortality rate (0.6% vs 6.8%, P = 0.03; hazard ratio [HR] = 8.16, 95% confidence interval [CI]: 1.27-74.48, P = 0.03). In addition, 10 out of 176 (5.7%) patients without CAD and nine out of 44 (20.5%) patients with CAD achieved the secondary endpoints (progressive heart failure, unexplained syncope, stroke, atrial fibrillation, and myocardial infarction) (HR = 2.89, 95%CI: 1.03-8.12, P = 0.04). The 5-year survival rate and cardiovascular event-free survival rate were significantly higher in patients without CAD than in those with CAD (97.4% vs 93.9%, P = 0.03; 89.2% vs 80.1%; P = 0.04). In the multivariate analysis, presence of CAD, New York Heart Association class, and left atrial diameter were predictors of combined cardiovascular events when adjusted for age and male sex.Conclusions: The cardiovascular death and cardiovascular events are significantly increased in patients with HOCM and CAD who underwent CABG at the time of septal myectomy. [ABSTRACT FROM AUTHOR]

Objective This study aims to report our preliminary experience and anatomic findings in the surgical treatment and postoperative management of hypertrophic obstructive cardiomyopathy. Methods This study included 277 patients with hypertrophic obstructive cardiomyopathy (168 [60.65%] were male), with a median age of 47 years (interquartile range, 35-54 years), who underwent surgical myectomy performed by 1 surgeon in Fuwai Hospital between May 2010 and April 2015. The median follow-up was 14 months (interquartile range, 7-24 months). Results A total of 127 patients (45.85%) underwent concomitant procedures, and 2 patients (0.72%) died in the early perioperative days. The left ventricular outflow gradient decreased from 78 mm Hg (interquartile range, 61-100 mm Hg) to 11 mm Hg (interquartile range, 8-15 mm Hg) when discharged ( P < .001). Of the 228 patients with well-documented anatomic description, more than 80% had various intraventricular anomalies. The cumulative survival was 99.28% (95% confidence interval, 97.15-99.82) at 1 year and 96.98% (95% confidence interval, 92.56-98.79) at 5 years. Of the surviving 272 patients, 268 (98.53%) were categorized with functional class I and II of the New York Heart Association classification at the latest evaluation. Conclusions Anomalous muscle bundles are common in hypertrophic obstructive cardiomyopathy, and they may lead to middle-apical obstruction. Surgical myectomy provides excellent clinical outcomes with low risk for sufficient relief of obstruction and radical correction of intraventricular anomalies in patients with hypertrophic obstructive cardiomyopathy. [ABSTRACT FROM AUTHOR]

Mitral annular calcification (MAC) is a risk factor for cardiac surgery, but there is limited study on the prognosis value and the impact for valve function of MAC based on computed tomography (CT) diagnosis after myectomy for hypertrophic obstructive cardiomyopathy (OHCM). Consecutive OHCM patients underwent septal myectomy were compared according to the existence of MAC and its severity in preoperative CT scans. The survival data were evaluated and compared by Kaplan Meier analysis and log rank test. Cox regression analysis was used to evaluate the impact of MAC on endpoint events. From the entire cohort of 1035 patients, 10.8% had MAC. In multivariate regression, female (OR = 2.23), age (OR = 1.07), aortic annular calcification (OR = 2.52), aortic calcification (OR = 2.56), systolic anterior motion of the mitral valve (SAM) (OR = 0.42), mitral valve thickening (OR = 2.13), and tricuspid regurgitation (OR = 3.12) were independent predictors of MAC. All-cause mortality (3.57% vs. 1.08%, p = 0.031), major adverse cardiovascular and cerebrovascular events (MACCE) (23.32% vs. 13.65%, p = 0.014), recurrent MR > 2+ (8.04% vs. 2.49%, p = 0.001) and NYHA III-IV (11.61% vs. 5.53%, p = 0.012) were more frequent in OHCM patients with MAC after myectomy. MAC was discovered to be an independent predictor of postoperative recurrent MR > 2+ after other risk factors were taken into account (HR 2.47, 95% CI 1.08–5.67, p = 0.0329). Moderate-to-severe MAC was an independent risk factor (HR 2.03, 95% CI 1.09–3.75, p = 0.0244) for long-term major adverse cardiovascular and cerebrovascular events (MACCE). MAC was detected in one-tenth of OHCM patients in preoperative CT scanning and is mainly associated with aging and atherosclerosis. OHCM patients with MAC had a worse prognosis and more recurrent mitral valve regurgitation than those without MAC after septal myectomy. • The incidence of mitral annulus calcification in patients who had septal myectomy for hypertrophic obstructive cardiomyopathy was 10.8% in this large-scale CT diagnostic research. • There were the following baseline predictors of mitral annulus calcification: female, older age, aortic annular calcification, aortic calcification, systolic anterior motion of the mitral valve, mitral valve thickening, and preoperative tricuspid regurgitation. • In long-term follow-up, patients with mitral annulus calcification have a worse prognosis. Moderate-to-severe MAC was the risk factor for MACCE, and MAC was the risk factor of recurrent mitral regurgitation. • To reduce the risk posed by operating on calcified annulus, we used multiple surgical techniques. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obstructive sleep apnoea (OSA) is high in patients with hypertrophic cardiomyopathy. The effect of septal myectomy on OSA is not clear. This study aimed to examine the association between hypertrophic obstructive cardiomyopathy and OSA before and after septal myectomy.Method: We included 85 consecutive patents with a confirmed diagnosis of hypertrophic obstructive cardiomyopathy who underwent septal myectomy. Polysomnography was performed in all patients before and 3 months after the surgery.Results: Of the 85 patients, 49 (58%) were diagnosed with OSA. Patients with OSA were significantly older than those without OSA. The incidence of atrial fibrillation significantly increased during the perioperative period in patients with OSA (p = 0.03). The severity of OSA significantly increased 3 months after surgery, as determined by the apnoea-hypopnoea index (AHI; p < 0.001), obstructive apnoea index (p = 0.024), and hypopnoea index (p = 0.003), whereas central apnoea index was decreased (p = 0.008). In the multivariate linear regression analysis, mean oxygen desaturation and time% with SpO2 <90% during sleep before surgery were significantly associated with increased AHI, independently of body mass index and sex (p = 0.026 and p = 0.007, respectively; adjusted R2 = 0.365).Conclusions: The severity of OSA significantly increased 3 months after septal myectomy as determined by AHI, obstructive apnoea index, and hypopnoea index. Mean oxygen saturation and time% with SpO2 <90% during sleep before surgery were independently associated with the increase of AHI. However, the specific mechanism of such deterioration of OSA after septal myectomy needs to be determined in detail. [ABSTRACT FROM AUTHOR]