Beta-Blocker therapy improves survival after concomitant septal myectomy and aortic valve replacement

The coexistence of hypertrophic obstructive cardiomyopathy (HOCM) and aortic stenosis (AS) often requires concomitant septal myectomy and aortic valve replacement (AVR). However, data on outcomes and medical management remain limited. This study investigates the impact of beta-blockers on long-term survival in patients undergoing concomitant septal myectomy and AVR. We conducted a retrospective cohort study of 55 patients with moderate-to-severe AS and HCM who underwent myectomy and AVR at our center from 2007 to 2021. We evaluated baseline characteristics, postoperative data, and survival. Kaplan-Meier and Cox proportional hazards analyses identified predictors of survival. The mean age was 74 ± 8 years and 67% were female. Severe AS was present in 84% and 53% had HOCM. Cardiovascular risk factors were prevalent, including hypertension (80%), dyslipidemia (82%), and smoking history (53%). Postoperatively, 55% of patients experienced complications, including new-onset atrial fibrillation (35%) and complete heart block requiring permanent pacemaker implantation (33%). Beta-blocker use increased from 65% at admission to 84% at discharge. Median survival was 9.7 years, with 5-year and 8-year mortality rates of 22% and 49%, respectively, significantly lower than an age- and sex-matched control cohort (median survival 12.5 years). Beta-blockers were independently associated with improved survival (HR 0.27, 95% CI: 0.12–0.67) while smoking history predicted mortality (HR 4.07, 95% CI: 1.76–10.54). Beta-blockers improved survival following septal myectomy and AVR while smoking history predicted mortality. Despite reduced outflow gradients, postoperative complications were common, emphasizing the need for improved treatment strategies. Further studies are needed to optimize postoperative management.