Impact of preoperative computed tomography planning on surgical outcomes in patients with obstructive hypertrophic cardiomyopathy: A prospective cohort study.

Abstract

To evaluate the impact of computed tomography (CT)-guided planning on surgical myectomy outcomes in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) and/or midcavity obstruction by comparing these outcomes with those of conventional surgical myectomy. This prospective cohort study included patients who underwent surgical septal myectomy for HCM with LVOT and/or mid-cavity obstruction between January 2019 and May 2024 at a single tertiary center. In the CT-planned myectomy group, an expert radiologist simulated the target myectomy site through a series of postprocessing methods to plan the surgical approach, provide a surgeon's view that closely resembles the actual perspective in the operating room, and determine the target myectomy volume. The conventional myectomy group underwent imaging studies, including echocardiography and cardiac CT; however, surgical planning was done using standard methods without CT-based postprocessing. Baseline clinical findings, surgery-related factors, and clinical outcomes were compared between the 2 groups. Multivariable logistic regression was used to evaluate the impact of preoperative CT planning on clinical outcomes. A total of 117 patients (median age, 62.2 years; interquartile range, 50.7-69.0 years; 62 women) were included, with 47 (40.2%) in the CT-planned myectomy group. The operation time was shorter in the CT-planned myectomy group compared to the conventional myectomy group (3.8 hours vs 4.3 hours; P = .01). The incidence of left bundle branch block (LBBB) was significantly lower in the CT-planned group (42.6% vs 67.1%; P = .01). No significant differences between the 2 groups were found in major adverse events, including cardiovascular death, complete atrioventricular block, and iatrogenic ventricular septal defects. Multivariable analysis showed that CT-planned myectomy was associated with lower odds of developing postoperative LBBB (odds ratio, 0.32; 95% confidence interval, 0.14-0.70; P = .005). CT-planned myectomy in patients with obstructive HCM was associated with shorter operation times and a reduced risk of postoperative LBBB compared with conventional myectomy, without an increase in major complications.