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Midterm results of different treatment methods for myocardial bridging in patients after septal myectomy
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  • Shengwei Wang,
  • Shuiyun Wang,
  • Yongqiang Lai,
  • Yunhu Song,
  • Hao Cui,
  • Changpeng Song,
  • Liukun Meng,
  • Changsheng Zhu,
  • Rong Wu,
  • Xiaohong Huang
Shengwei Wang
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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Shuiyun Wang
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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Yongqiang Lai
Capital Medical University Affiliated Anzhen Hospital
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Yunhu Song
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Hao Cui
Mayo Clinic Division of Cardiovascular Diseases
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Changpeng Song
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Liukun Meng
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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Changsheng Zhu
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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Rong Wu
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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Xiaohong Huang
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
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Abstract

Background: Myocardial bridging (MB) is commonly treated in patients with hypertrophic cardiomyopathy (HCM). 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=0.89) and cardiovascular death (98.3% vs 100% vs 100% vs 98.4%, p=0.63) were similar among the four groups (non-MB, CABG, unroofing, untreated, respectively). The 3-year cumulative event-free survival of nonfatal MI (100% vs 97.5% vs 98.0% vs 89.9%, p<0.001) and combined endpoints (97.9% vs 97.5% vs 98.0% vs 88.4%, p=0.02) were significantly lowest in untreated MB. Cox regression analysis indicated that untreated MB was a significant independent predictor of combined endpoints (hazard ratio [HR]: 4.06, 95% confidence interval [CI]: 1.60–10.32, p<0.001). Moreover, 49 patients underwent coronary artery computed tomography after surgery. The patency rate of the saphenous vein graft (SVG) was significantly higher than that of the left internal mammary artery (LIMA) (13.3% vs 84.2%, p<0.001). 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.

Peer review status:Published

18 Sep 2020Submitted to Journal of Cardiac Surgery
18 Sep 2020Submission Checks Completed
18 Sep 2020Assigned to Editor
19 Sep 2020Reviewer(s) Assigned
28 Sep 2020Review(s) Completed, Editorial Evaluation Pending
28 Sep 2020Editorial Decision: Revise Major
18 Oct 20201st Revision Received
19 Oct 2020Assigned to Editor
19 Oct 2020Submission Checks Completed
19 Oct 2020Reviewer(s) Assigned
09 Nov 2020Review(s) Completed, Editorial Evaluation Pending
09 Nov 2020Editorial Decision: Revise Minor
14 Nov 20202nd Revision Received
18 Nov 2020Submission Checks Completed
18 Nov 2020Assigned to Editor
18 Nov 2020Reviewer(s) Assigned
19 Nov 2020Review(s) Completed, Editorial Evaluation Pending
19 Nov 2020Editorial Decision: Accept
Dec 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.15226