Improvement in gastrointestinal bleeding after septal myectomy for hypertrophic cardiomyopathy

Daokun Sun, Hartzell V. Schaff, Juliano Lentz Carvalho, Rick A. Nishimura, Joseph A. Dearani, Steve R. Ommen, Joseph L. Blackshear, Jeffrey B. Geske

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Patients with obstructive hypertrophic cardiomyopathy may have occult gastrointestinal bleeding. In this study, we analyzed outcomes of septal myectomy in patients who had a history of gastrointestinal bleeding preoperatively to understand patient characteristics and impact of septal reduction on recurrent gastrointestinal bleeding. Methods: We analyzed 73 adult patients who had a history of gastrointestinal bleeding before transaortic septal myectomy for obstructive hypertrophic cardiomyopathy and compared outcomes to 219 patients without gastrointestinal bleeding preoperatively. Results: Patients with preoperative history of gastrointestinal bleeding were older (median (IQR) age, 65 (59-69) years, P <.001) and were more likely to have systemic hypertension (70% vs 53%, P =.020) and coronary artery disease (25% vs 13%, P =.026). Preoperatively, patients with gastrointestinal bleeding had a larger left atrial volume index (median, 53 mL/m2; interquartile range, 42-67; P =.006) and greater right ventricular systolic pressure (median, 36 mm Hg; interquartile range, 32-49; mm Hg, P =.005) but no significant difference in severity of outflow tract obstruction (P =.368). There were no perioperative deaths. The estimated 5- and 10-year survivals were 96.6% and 81.8%, respectively. At a median of 3.4 (interquartile range, 1.9-9.1) years after septal myectomy, 11 patients (15%) had recurrence of gastrointestinal bleeding, which was attributed to angiodysplasia or unknown causes in 6 patients (8%). Conclusions: Patients with a preoperative history of gastrointestinal bleeding have favorable short- and long-term outcomes after septal myectomy for obstructive hypertrophic cardiomyopathy. Remission of gastrointestinal bleeding was observed in 85% of patients postprocedure, and only 8% of the patients had recurrent gastrointestinal bleeding due to angiodysplasia or unknown causes.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume167
Issue number1
DOIs
StatePublished - Jan 2024

Keywords

  • anemia
  • gastrointestinal bleeding
  • hypertrophic cardiomyopathy
  • septal myectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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