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Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure

Anita Nguyen1, Hartzell V Schaff1, Rick A Nishimura2

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.

The Journal of Thoracic and Cardiovascular Surgery
|May 5, 2019
PubMed

Insights

Transapical myectomy improves symptoms and survival in apical hypertrophic cardiomyopathy patients. This procedure offers a low early risk and better long-term outcomes compared to heart transplantation.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • Apical hypertrophic cardiomyopathy (AHC) can cause reduced left ventricular volume, diastolic dysfunction, angina, and arrhythmias.
  • Transapical myectomy aims to increase left ventricular cavity size, improving stroke volume and reducing end-diastolic pressure.

Purpose of the Study:

  • To evaluate early outcomes of transapical myectomy in AHC patients.
  • To compare survival rates of AHC patients undergoing myectomy versus those listed for heart transplantation.

Main Methods:

  • Retrospective review of 113 AHC patients who underwent transapical myectomy (September 1993 - March 2017).
  • Analysis of clinical and echocardiographic data.
  • Comparison of survival using a national database against AHC patients awaiting heart transplantation.

Main Results:

  • 4% 30-day mortality post-myectomy.
  • 76% of patients reported symptom improvement at follow-up.
  • Estimated 1-, 5-, and 10-year survivals were 96%, 87%, and 74%, appearing superior to heart transplant candidates.

Conclusions:

  • Apical myectomy is a beneficial intervention for severely symptomatic AHC patients.
  • The procedure has a low early risk and provides sustained clinical improvement for most patients.
  • Long-term survival post-myectomy seems favorable compared to medical management and heart transplantation waiting lists.
Abstract

Keywords:
apicalhypertrophic cardiomyopathymyectomy

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