ª 2013 by the American College of Surgeons

Published by Elsevier Inc.

CARDIOTHORACIC SURGERY II

Surgical correction of hypertrophic obstructivecardiomyopathy with mid-ventricle obstructionDmitry A Malenkov, MD, Leo A Bockeria, MD, PhD, FACS(Hon),Marina I Berseneva, MD, PhD, Inga V Tetvadze, MD, PhDBakoulev Scientific Center for Cardiovascular Surgery, Moscow,

Russian Federation

INTRODUCTION: Many different surgical techniques were offeredto treat hypertrophic obstructive cardiomyopathy (HOCM) last 50

years. As clinical and anatomical characteristics vary in HOCMpatients, an individual approach is needed in every case to achieveappropriate results. The mid-ventricle obstruction could be caused

by one or combination of factors: IVS hypertrophy and protuber-ance, hypertrophy and abnormal anatomy of papillary muscles,systolic-anterior motion of mitral leaflet.

METHODS: From 2000 to 2012, 330 patients aged 3-70 years

underwent surgical correction of HOCM. Most of the patientswere in New York Heart Association class III. Preoperativel exam-ination included: electrocardiography, cardiac ultrasound, chestx-ray, 24h Holter monitoring, MRI with gadolinium, and catheter-

ization. Surgical septal myectomy from right ventricle with patchwas performed in 165 patients.

RESULTS: Control examinations were held at 6, 12, 24, and 60months after operation. On discharge, LVOT peak gradient

decreased by half or more in the majority of patients. 12months aftersurgical correction the majority of patients showed an improvementof clinical state, which was proved by SF-36 Health Survey, LV and

RV diastolic function according to cardiac ultrasound, and BNPlevel. Overall surgical survival after 5 years was 98%.

CONCLUSIONS: Our experience with surgical septal myectomy

from the RV with patch provides optimum elimination of theanatomic substrate of obstruction and allows improvement of thediastolic function of both ventricles and the quality of life in

patients with the mid-ventricle form of HOCM.

Antihypertensive strategies in the management of aorticdiseaseScott L Maddalo, BA, Alison Ward, MD, Vittoria Flamini, PhD,Boyce Griffith, PhD, Patricia Ursomanno, PhD, RN, NP,Abe DeAnda, MD, FACSNew York University School of Medicine, New York, NY

INTRODUCTION: Aortic disease continues to have a significantimpact on mortality. The relationship of hypertension and pressure

impulse (dP/dt) on the propagation of aneurysms and initiation ofdissections is well established. Various medications have been usedin the management of patients with aortic disease, but no analyseshave compared the effect of antihypertensive drugs on pulse pres-

sure (PP) or dP/dt.

METHODS: A literature search for trials on normotensive patients

given antihypertensive medications was performed to identify rele-vant hemodynamic data. The changes in systolic and diastolic pres-sures before and after administration of drugs were used to

calculate PP. dP/dt was extrapolated from PP assuming the lengthof mechanical systole to be consistent for all medications.

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RESULTS: Twelve studies were found analyzing antihypertensivemedication effects on hemodynamic data. Combination alpha

and beta-blockers demonstrated the greatest decrease in PP (labeta-lol 400 mg, -28.0�19.7 mmHg) and dP/dt. Selective beta-blockersalso demonstrated a large decrease in PP (esmolol 750 ug/kg/min,

-23.4�6.9 mmHg). Nicardipine had the smallest effect (20 mgTID, -1.0�21.3 mmHg). Tiapamil was the only medication thatcreated an increase in PP (25ug/kg/min, 3.0�15.6 mmHg).

ACE inhibitors and ARBs exhibited less effect on PP than labetalolor beta blockers.

dP dP dP

Antihypertensive

http:/

systolic

/dx.doi.org/1

diastolic

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llsurg.2013.07

SD

Labetalol

�21.0 �7.0 �28.0 19.7

Propranolol

�19.0 4.0 �15.0 20.8

Esmolol

�19.4 �4.0 �23.4 6.9

Tiapamil

6.9 �3.6 3.3 15.6

Captopril

�1.9 �5.2 �7.1 18.5

Valsartan

�3.6 �2.4 �6.0 22.7

Trichlormethiazide

11.0 �22.0 �11.0 10.8

Nicardipine

4.0 �5.0 �1.0 21.3

Nitroprusside

�5.0 �5.0 �10.0 17.3

CONCLUSIONS: Labetalol and esmolol showed the greatestdecrease in PP and consequently, dP/dt with the inferences used.

Nicardipine demonstrated the smallest effect on PP and dP/dt.Based on this analysis, combined alpha, beta-blockers and selectivebeta-blockers would be better treatment choices to slow progressionof aortic disease.

Minimally invasive esophagectomy is feasible in patientswho underwent induction chemoradiationRona Spector, MD, Abraham Lebenthal, MD,Jon O Wee, MD, FACS, Yifan Zheng, MD, Peter C Enzinger, MD,Harvey Mamon, MD, PhD, Steven J Mentzer, MD, FACS,David E Marchosky, MD, Michael T Jaklitsch, MD, FACS,Raphael Bueno, MD, FACSBrigham and Women’s Hospital, Boston, MA

INTRODUCTION: To evaluate the feasibility of minimally invasiveesophagectomy (MIE) after induction including radiation and the

associated perioperative and long-term outcomes of this operation.

METHODS: Of 1196 esophagectomies performed between 1990-2012, 122 three-hole MIE cases were reviewed for perioperativeparameters and outcomes.

RESULTS: Median age, 63.6 years; histology: adenocarcinoma

(90), squamous carcinoma (18), high grade dysplasia (10), neuro-endocrine tumor (1), melanoma (1), achalasia (1), and stricture (1).Tumor locations: upper (2), middle (16), distal (67), and GE

junction (36). Seventy-three patients were at clinical stage IIAor above on presentation. Seventy-seven received neoadjuvant che-moradiotherapy. Median operative time: 389 (236-716) minutes

and median estimated blood loss was 300 (100-1500) cc. Meanproximal and distal margin lengths were 6 and 5 cm. Six patients

6.00

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