Is Concomitant Septal Myectomy during Aortic Valve Replacement Associated with an Increase in Adverse Events? A Single-Center Comparative Study

Objectives: Septal myectomy during aortic valve replacement (AVR) is widely used and an effective surgical treatment for secondary basal septal hypertrophy. Concerns regarding higher rates of complications associated with this procedure—such as permanent pacemaker implantation or ventricular septal defects—have been raised. The aim of this study is to compare outcomes and complications of patients with and without concomitant septal myectomy in a propensity adjusted matching model.

Methods: Over a period of 6 years (2009–2015), a total of 2,199 consecutive nonemergency patients were included. Patients received either AVR (N = 1,987) or AVR with concomitant myectomy (N = 212). As reference to previously published data, patient characteristics and outcomes of the overall cohort were examined and described. Subsequent group comparisons were performed using a nearest neighbor matching approach.

Results: In the unmatched cohort, patients with isolated AVR were younger (68 ± 10 vs. 71 ± 8 years, p < 0.001), more often male (63 vs. 32%, p < 0.001), and needed on average larger aortic valve prostheses (23.5 ± 1.9 vs. 22.4 ± 1.6 mm, p < 0.001) in comparison to patients with additional septal myectomy. After matching (N = 374) no statistically significant differences in baseline features were evident. Both groups did not demonstrate significant differences in hospital mortality (1.6 vs. 2.1%, p = 1.000) and pacemaker-implantation rates (3.7 vs. 5.3%, p = 0.621). Midterm survival between groups was comparable (84.4 ± 5% vs. 86.1 ± 5% at 6 years, p = 0.957) and similar to a regional population after adjustment for age and sex (p = 0.178).

Conclusion: This comparative study demonstrates that concomitant myectomy in patients undergoing AVR is a safe surgical technique, which seems not to lead to higher rates of relevant adverse events or inferior survival also in comparison to an age- and sex-matched regional population.