Surgical Treatment Of Hypertrophic Obstructive Cardiomyopathy Combined With Mitral Valve Annular Calcification And Related Research On Permanent Pacemaker Implantation After Myocardectom

Section 1:Risk factors and prognostic value of mitral annulus calcification in obstructive hypertrophic cardiomyopathy patients underwent septal myectomyBackgroundMitral annulus calcification(MAC)is a pathological change that increases the difficulty of surgery and may affect the prognosis of patients with hypertrophic obstructive cardiomyopathy(HOCM)undergoing septal myectomy.The purpose of this study is to determine the incidence of MAC in patients undergoing HOCM surgery,identify its risk factors,and evaluate the impact of MAC on patient prognosis.MethodsConsecutive HOCM patients underwent septal myectomy from 2016 to 2021 in our hospital were collected and 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.Risk factors for preoperative MAC were determined through Logistic regression.Cox multivariate regression is used to analyze and evaluate the impact of MAC on outcomes.ResultsFrom the entire cohort of 1035 patients,112(10.82%)had MAC.In multivariate regression,female,age,aortic annular calcification,aortic calcification,systolic anterior motion of the mitral valve(SAM),mitral valve thickening,and tricuspid regurgitation were independent predictors of MAC.All-cause mortality(3.57%vs.1.08%,P=0.031),major adverse cardiovascular and cerebrovascular events(MACCE)(23.21%vs.14.41%,P=0.015),recurrent MR(mitral regurgitation)>2+(8.04%vs.2.49%,P=0.001)and NYHA(New York Heart Association)Ⅲ-Ⅳ(11.61%vs.5.53%,P=0.012)were more frequent in HOCM patients with MAC after myectomy.MAC was discovered to be an independent predictor of postoperative recurrent MR>2+(HR=2.47).Moderate-to-severe MAC was an independent risk factor(HR=1.93)for MACCE.ConclusionThe occurrence of MAC in HOCM patients is associated with age,females,calcification in other regions,and baseline mitral and tricuspid valve status.HOCM patients with MAC had a worse prognosis and more recurrent mitral valve regurgitation than those without MAC after septal myectomy.Section2:Risk factors and prognosis of permanent pacemaker implantation in HOCM patients underwent septal myectomyBackgroundNew permanent pacemaker implantation(PPM)is a common complication for hypertrophic obstructive cardiomyopathy(HOCM)patients after surgical septal myectomy.The purpose of this study was to assess the risk factors and outcomes of PPM implantation in patients with HOCM after surgery.MethodConsecutive HOCM patients underwent septal myectomy in a single center were collected,and matched PPM and non-PPM groups were establish based on baseline propensity score matching.The perioperative and follow-up outcomes were compared between the two groups.A risk prediction model for postoperative PPM implantation was established through Cox regression.ResultA total of 1070 patients were included in the study,with a median follow-up of 2.2 years.A total of 39 patients(3.64%)underwent PPM implantation at the end point of the study.A matched cohort of 39 pairs(n=156)of PPM and non-PPM groups was established using a 1:3 proportional propensity score.The proportion of baseline diabetes,atrial fibrillation,right bundle branch block and previous alcohol septal ablation was higher in the PPM group.In the matched cohort,there was no significant difference between the two groups in long-term mortality,incidence of adverse events,and NYHA cardiac function grade.In the PPM group,the long-term left ventricular end diastolic diameter was larger,and the degree of mitral and tricuspid regurgitation was more severe.Age(HR=1.07),preoperative bundle branch block(HR=13.20),previous history of alcohol septal ablation(HR=6.39),and combined Maze procedure(HR=4.99)were independent risk factors for PPM implantation,while females were protective factor(HR=0.38).The area under the curve of the predict model is 0.854.ConclusionIncidence of postoperative PPM implantation in patients with HOCM after surgical myectomy was 3.64%.During long-term follow-up,there was no significant difference in mortality and adverse event incidence between PPM and non-PPM groups.Identification and attention to high-risk patients,such as baseline bundle branch block and previous alcohol ablation,can aid with PPM implantation strategy.