A total of 2506 adults were included; 1379 patients (55.0%) were men. Raphael Interestingly, women were less likely to undergo concomitant coronary artery bypass grafting (women, 80 [7.2%]; men, 140 [10.3%]; P = .008), but the percentage who underwent concomitant valve operations was not significantly different (women, 451 [40.7%]; men, 509 [37.4%]; P = .10). Risk of 30-day mortality was 0.8% in this review, and there were no differences in early outcomes between women and men. Download : Download high-res image (342KB) Previously, the standard surgical procedure for HCM was septal myectomy (SM) (Morrow procedure). In a multivariable Cox regression analysis, however, the association between sex and mortality was attenuated and not significant after controlling for other baseline variables (hazard ratio, 0.98 [95% CI, 0.76-1.26]; P = .86). The proportion of women with extreme anteroseptal wall thickness (≥30 mm) was slightly lower (women, 47 [4.4%]; men, 85 [6.4%]; P < .001). Multivariable Cox proportional hazards modeling was used to assess the partial effect of sex on time until death in the presence of known important baseline prognostic factors. Septal hypertrophy, measured as median (IQR) absolute anteroseptal thickness (women, 19 [17-23] mm; men, 20 [18-23] mm) and median (IQR) posterior wall thicknesses (women, 13 [11-15] mm; men, 14 [12-15] mm), was less pronounced in women (both P < .001).  LK, Robb  JT, At the time of surgery, women were older, with a median (IQR) age of 59.5 (46.6-68.2) years vs 52.9 (42.9-62.7) years for men (P < .001), and were more symptomatic, with higher likelihood of being in NYHA class III or IV at presentation (women, 1023 [90.8%]; men, 1169 [84.8%]; P < .001). Overall survival after septal myectomy was worse in women than men. Statistical tests for assessing baseline differences by sex were based on the Wilcoxon-Kruskal-Wallis test for continuous or ordinal variables and the Pearson χ2 test for categorical variables. Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy.  L, Fuchs AV, aortic valve; MV, mitral valve; TV, tricuspid valve; CABG, coronary artery bypass graft.  A, Borger In more recent years, the median age of both women and men has increased, and preoperative resting gradient has decreased (eTable in the Supplement). Left ventricular outflow tract gradients were obtained by continuous-wave Doppler interrogation of the LVOT from an apical window and calculated using the modified Bernoulli equation (gradient = 4VLVOT2, where VLVOT is peak LVOT velocity).  MA,  JA, Maron  E, However, to our knowledge, there are no large studies of the association of patient sex with outcomes after surgical myectomy. was 11% in the myectomy patients and 40% in the medical group (p <0.0001).  Y, Wang In the unadjusted analysis (Figure 1A), women had lower survival than men after myectomy, corresponding to an apparent 3.9-year shorter median survival time (median [IQR] survival time: men, 22.1 [15.1-32.5] years; women, 18.2 [12.1-27.2] years). Determinants of reverse remodeling of the left atrium after transaortic myectomy. 2019;4(3):237–245. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2019;4(3):237-245. doi:10.1001/jamacardio.2019.0084. Although the unadjusted analysis demonstrated worse survival in women (Figure 1A), this difference was attenuated in an adjusted model (Figure 1B). Including two operative deaths (procedural mortality, 0.8%), 1-, 5-, and 10-year overall survival after myectomy was 98%, 96%, and 83%, respectively, and did not differ from that of the general U.S. population matched for age and gender (p = 0.2) nor from patients with nonobstructive HCM (p = 0.8). Since these variables are modeled nonlinearly, general tests of association can easily generate significant P values, even when the confidence interval of a hazard ratio contains 1.0. Ejection fraction, left ventricular (LV) cavity size, LV mass, and wall thickness were determined as previously described.18 Mitral regurgitation was graded as none to trivial (0), mild (1), moderate (2), moderately severe (3), or severe (4) after analyzing jet area and width, and spectral Doppler intensity, as well as regurgitation quantitation with the continuity and/or proximal isovelocity surface area method, as appropriate.19 Mitral regurgitation could not be quantitated in all patients due to jet eccentricity and LVOT turbulence merging with the regurgitant jet flow convergence.  M, Left anterior descending artery dissections occurred in 8 … Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.  et al. 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