Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy

Hypertrophic cardiomyopathy is a genetic disorder of the myocardium, characterized by marked myocardial hypertrophy that may lead to the development of symptoms such as dyspnea, angina pectoris, or stress-induced syncopes, with an increased risk of sudden cardiac death, due to obstruction of the left ventricular outflow tract (hypertrophic obstructive cardiomyopathy). Septal reduction treatment is needed in these patients, in order to relieve of the symptoms. In addition, mitral valve apparatus should be assessed in these patients, in order to recognize a dynamic movement of the MV during systole anteriorly toward the LVOT. In this chapter, we will describe the current surgical management of HOCM

Transcatheter Cardiac Surgery

The introduction of transcatheter aortic valve implantation (TAVI) have changed the management of patients affected by severe aortic stenosis. Nowadays, TAVI procedure represents the treatment of choice in patients with severe AS inoperable or at high risk. MDCT is the technique of choice in preoperative planning: it provides information regarding aortic valve and vascular access. Particular attention should be paid on bicuspid valve morphology. The choice of valve is, basically, based on confidence and experience of the operator and center

Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study

Objectives: The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies. Methods: The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299). Results: No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases. Conclusions: Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes. Keywords: Endocarditis; Isolated tricuspid valve disease; Tricuspid valve