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Surgical management of hypertrophic obstructive cardiomyopathy

Arzu Antal1, Kamil Boyacıoğlu2, Mustafa Akbulut3

  • 1Clinic of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Research Center, Istanbul, Turkey. arzuantal@yahoo.com.

General Thoracic and Cardiovascular Surgery
|February 11, 2020
PubMed

Insights

Septal myectomy effectively treats hypertrophic obstructive cardiomyopathy, improving symptoms and reducing outflow tract gradients. Combining it with mitral valve procedures is safe and does not increase patient risk.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Surgery Outcomes

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) significantly impacts patient quality of life.
  • Septal myectomy is a primary surgical intervention for drug-refractory HOCM symptoms.
  • The role of concomitant mitral valve procedures requires further outcome evaluation.

Purpose of the Study:

  • To evaluate the outcomes of septal myectomy alone versus combined with mitral valve surgery in HOCM patients.
  • To assess the safety and efficacy of surgical myectomy in improving HOCM symptoms and hemodynamic parameters.

Main Methods:

  • Retrospective analysis of 41 symptomatic HOCM patients (2011-2016).
  • Patients underwent septal myectomy alone (n=21), septal myectomy with mitral valve repair (n=10), or septal myectomy with mitral valve replacement (n=10).
  • Average follow-up was 38.45 months.

Main Results:

  • All patients experienced symptomatic improvement, with resolution of NYHA Class III/IV symptoms.
  • Significant reduction in left ventricular outflow tract gradient (116.65 to 22.47 mmHg) and septal thickness (2.35 to 1.74 cm).
  • Low complication rate: 1 pacemaker, 2 intracardiac devices for arrhythmia; 2.4% operative mortality. No repeat procedures needed.

Conclusions:

  • Septal myectomy is a safe and effective treatment for symptomatic HOCM.
  • Concomitant mitral valve operations do not elevate morbidity or mortality risks.
  • Surgical myectomy offers significant hemodynamic and symptomatic benefits in HOCM management.
Abstract

Keywords:
Hypertrophic obstructive cardiomyopathySeptal myectomy

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