Perioperative treatment of hypertrophic obstructive cardiomyopathy

Xiao Ying-kai; Zhou Cheng-bin; Xiong Wei-ping; Xie Bin; Huang Huan-lei; Guo Hui-ming

doi:10.13498/j.cnki.chin.j.ecc.2015.04.10

Abstract：Objective To summarise the clinical experience on the perioperative treatment of hypertrophic obstructive cardio?myopathy( HOCM) . Methods Forty six patients with HOCM who had undergone surgical treatment during the period of January 2010 to December 2014 were included in this study. Emergencyventricular septal myectomy was performed through the aortic incision under extracorporeal circulation( ECC) . The concomitant operations included mitral valve replacement( 11cases) ,mitral valvuloplasty ( 4 ca?ses),aortic valve replacement (4 cases),and tricuspid valvuloplasty (5 cases). Results The ECC and aortic occlusion time was (144.3±64.4)min and (91.2±36.4)min respectively.The endotracheal intubation time was (20.3±14.6) h and the postoperative inten?sive care unit(ICU)stay was (66.3±35.6) h. Two cases died and the mortality was 4.3%. The main causes of death included cerebro?vascular accident and multiple organs failure. The postoperative complications included supraventricular tachycardia in 7 cases (15.2%), ventricular arrhythmia in 4 cases (8.7%), complete left bundle branch block in 8 cases (17.4%), complete artioventricalblock in 1 cases (2.2%), intra-aortic balloon pump in 2 cases(4.3%) dueto low cardiac output syndrome, hemodialysis in 2 cases (4.3%) due?to acute renal failure, exploration for bleeding in 1 case(2.2%),reoperation in 1 case due to ventricular septal perforation. Postopera?tive echocardiography demonstrated a reduced LVOT gradient (12.8±10.9) mm Hg, P =0.002. Conclusion Concomitant ventricular septal myectomy is an effective and safe treatment for HOCM.The strengthened perioperative ECC management,and intensive care on the hemodynamic states after operation could reduce the complication and lower thesurgical risk.