The first 200 septal myectomies: Ensuring gold standard outcomes

Area of Science:

• Cardiology
• Cardiac Surgery
• Hypertrophic Cardiomyopathy

Background:

• Septal myectomy is the gold standard for drug-refractory symptomatic left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy.
• Access to this surgery is limited by geography, hindering many patients who would benefit.
• Establishing new hypertrophic cardiomyopathy programs is crucial for wider patient access.

Purpose of the Study:

• To report the initial experience of two newly established hypertrophic cardiomyopathy programs performing septal myectomies.
• To evaluate the safety and efficacy of septal myectomy in a complex patient population.

Main Methods:

• Retrospective review of septal myectomy procedures performed since 2014 at two new hypertrophic cardiomyopathy programs.
• Analysis of patient demographics, pre-operative symptoms, intraoperative findings, and post-operative outcomes.

Main Results:

• Two hundred septal myectomies were performed on patients with a mean age of 58.8 years; 95.5% had advanced heart failure symptoms.
• Mean intraventricular gradient was 89 mmHg; 48.5% required concomitant procedures.
• No perioperative mortality; 92% achieved gradients ≤ 15 mmHg; 97% had none/mild mitral regurgitation post-operatively.

Conclusions:

• Septal myectomy in new hypertrophic cardiomyopathy centers can safely and effectively treat complex patients.
• The procedure successfully abolishes left ventricular obstruction and resolves systolic anterior motion-mediated mitral regurgitation.
• Outcomes align with established hypertrophic cardiomyopathy guidelines, demonstrating the feasibility of expanding surgical access.