Dez anos de miectomia alargada como tratamento da cardiomiopatia hipertrófica obstrutiva

Abstract

Introduction Hypertrophic obstructive cardiomyopathy (HOCM) is a common hereditary condition affecting the heart and surgery plays a major role in its treatment. Gender differences in clinical presentation and treatment outcomes are currently in debate. Our aim is to describe the population of HOCM patients in whom extended myectomy was performed in our tertiary care facility, between 2007 and 2017, and characterise sex differences before and after surgical treatment. Methods The data was collected from the records, paper or electronic, in all patients with a main operative diagnosis of HOCM between January 2007 and December 2017. Pre-operative demographics, clinical and diagnostic work-up information, intra-operative variables and post-operative outcomes were collected. Statistical analysis was performed using the SPSS software v25.0 (IBM® SPSS® Statistics). Results From the 37 patients included in the analysis, 17 were man (45,9 %). In comparison with male patients, female patients were more symptomatic (greater proportion of patients in New York Heart Association [NYHA] functional classes III or IV; p=0.006). Their pre-operative study showed higher indexed left atrial diameter (p = 0.06) and higher incidence of atrial fibrillation (p = 0.014). After surgery, interventricular septum and left ventricle outflow resting gradient reductions are similar between genders, but transition to lower NYHA classes is significant for females (p = 0,003), but not for male patients. Kaplan-Meier analysis demonstrated higher mortality in women compared with men (p = 0,033, Mantel-Cox). Conclusions Female patients seem to be in worse clinical condition upon presentation to surgery and show markers of more advanced disease. After surgery, females are also the ones presenting greater functional improvement. We need to focus on a more comprehensive approach in patient preoperative study and increase the sensitivity for disease diagnosis in earlier stages in the female population.