Septal Myectomy in Pediatric Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis.
Anelise Poluboiarinov Cappellaro, Luiz Felipe Costa de Almeida, Ronaldo Altenburg Odebrecht Curi Gismondi et al.
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In 30 seconds
This systematic review and meta-analysis assessed surgical outcomes after septal myectomy in children with obstructive hypertrophic cardiomyopathy. Eight clinical trials involving 490 patients were included. Pooled early and late mortality rates were 3.3% and 8.5%, respectively. Echocardiographic findings showed a reduction in mean left ventricular outflow tract gradient from 86.9 to 16.2 mmHg, with preserved left ventricular ejection fraction. Mitral regurgitation and systolic anterior motion also decreased. The authors describe the procedure as associated with favorable survival and hemodynamic improvement, while cautioning that the evidence is based on moderate-quality retrospective data.
Key findings
- Pooled early and late mortality rates were 3.3% and 8.5%, respectively.
- Mean LVOT gradient decreased from 86.9 to 16.2 mmHg, with preserved left ventricular ejection fraction.
- Mitral regurgitation decreased from 49.8 to 6.4%, and systolic anterior motion from 84.9 to 19.9%.
- Complete atrioventricular block occurred in 9.9% of patients, and permanent pacemaker implantation in 5.1%.
Why it matters
The findings summarize both hemodynamic improvement and important postoperative outcomes in children undergoing myectomy for obstructive HCM. They provide a useful overview of reported benefits and risks, including mortality and conduction complications, while the retrospective, moderate-quality evidence means estimates should be interpreted cautiously.
What to keep in mind
The authors note that the evidence is moderate-quality and retrospective.