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Outcome of septal myectomy in patients with hypertrophic obstructive cardiomyopathy

O Havndrup1, G Pettersson, K Kjeldsen

  • 1Department of Medicine B, H:S Rigshospitalet, University of Copenhagen, Denmark. havndrup@dadlnet.dk

Scandinavian Cardiovascular Journal : SCJ
|February 24, 2001
PubMed

Insights

Septal myectomy effectively reduces symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM) by decreasing left ventricular outflow tract gradients. This surgical option offers significant symptomatic relief for HOCM patients when medical therapy fails.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Medical Interventions

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents significant challenges in symptom management.
  • Septal myectomy is a known intervention for HOCM, but outcomes in smaller centers require evaluation.
  • Medical therapy often fails to adequately control symptoms in advanced HOCM.

Purpose of the Study:

  • To evaluate the clinical outcomes of septal myectomy in patients with HOCM.
  • To assess the efficacy and safety of septal myectomy in a smaller, non-specialized center.
  • To compare septal myectomy outcomes against alternative treatments for refractory HOCM.

Main Methods:

  • A retrospective study of 11 consecutive HOCM patients undergoing septal myectomy between 1991 and 1998.
  • Preoperative assessment included echocardiography and left-sided heart catheterization.
  • Procedures included Morrow myectomy (n=10) and modified Konno procedure (n=1).

Main Results:

  • Significant reductions in left ventricular outflow tract gradients (77 to 10 mmHg) and mitral regurgitation (1.7 to 0.8) were observed.
  • NYHA functional classification improved (2.4 to 1.5), and angina symptoms resolved in all affected patients.
  • No operative or early deaths occurred; one reoperation was needed for a suture leak. Long-term linearized mortality was 3.6% per year.

Conclusions:

  • Septal myectomy is an effective procedure for symptom relief in HOCM patients, likely due to gradient reduction.
  • These findings from a smaller center support myectomy as a viable therapeutic option.
  • Septal myectomy should be considered alongside other treatments like pacemakers or ablation when medical therapy is insufficient.
Abstract

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