Major adverse cardiovascular events after modified morrow surgery in hypertrophic obstructive cardiomyopathy: A 12-year cohort study

Zeng Xiaodong; Wu Hongxiang; Wang Ruobing; Huang Pingchuan; Xu Xuan; Zeng Ying; Huang Minjie; Song Xinze; Yuan Haiyun; Chen Jimei; Guo Huiming

doi:10.1016/j.ijcard.2024.132864

Major adverse cardiovascular events after modified morrow surgery in hypertrophic obstructive cardiomyopathy: A 12-year cohort study

Int J Cardiol. 2024 Nov 30:132864. doi: 10.1016/j.ijcard.2024.132864. Online ahead of print.

Authors

Affiliations

¹ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China.
² Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
³ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China. Electronic address: chenjimei@gdph.org.cn.
⁴ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China. Electronic address: guohuiming@gdph.org.cn.

PMID: 39622347
DOI: 10.1016/j.ijcard.2024.132864

Abstract

Objective: This study investigates the incidence and risk factors for major adverse cardiovascular events (MACE) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing modified Morrow surgery. It also aims to develop a predictive model for MACE to improve clinical risk assessment.

Methods: This retrospective cohort study included 292 HOCM patients who underwent modified Morrow surgery. The primary endpoint was the incidence of MACE. Univariate and multivariate logistic regression were used to identify independent risk factors for MACE, and a predictive model was developed.

Results: MACE occurred in 39.04 % of patients (114/292), with 4.7 % mortality (14/292), 3.1 % cardiac arrest, 2.7 % requiring intra-aortic balloon pump (IABP) support, and 1.0 % requiring extracorporeal membrane oxygenation (ECMO). Low cardiac output syndrome occurred in 19.2 %, atrial fibrillation in 18.2 %, and third-degree atrioventricular block (AVB) in 3.1 %. Key risk factors included age (OR = 1.044), eGFR (OR = 1.025), preoperative pulmonary hypertension >30 mmHg (OR = 2.274), interventricular septal thickness (OR = 1.084), MRI delayed enhancement (OR = 2.021), and postoperative leukocytosis (OR = 1.061). The predictive model demonstrated strong performance (AUC = 0.815, P < 0.001).

Conclusion: Patients with HOCM undergoing modified Morrow surgery are at high risk of MACE. Key risk factors include age, eGFR, pulmonary artery pressure, septal thickness, MRI delayed enhancement, and postoperative leukocytosis. A predictive model based on these factors aids in tailoring perioperative management.

Keywords: Hypertrophic obstructive cardiomyopathy; Major adverse cardiovascular events; Modified morrow procedure; Risk factors; Risk prediction model.