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Transapical Ventricular Remodeling for Hypertrophic Cardiomyopathy With Systolic Cavity Obliteration

Daokun Sun1, Hartzell V Schaff1, Rick A Nishimura2

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

The Annals of Thoracic Surgery
|March 27, 2022
PubMed

Insights

Transapical septal myectomy safely improves heart function in hypertrophic cardiomyopathy (HCM) patients with systolic obliteration. This procedure offers a viable alternative to heart transplantation for advanced heart failure.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Failure Management

Background:

  • Hypertrophic cardiomyopathy (HCM) can cause reduced left ventricular (LV) stroke volume and systolic cavity obliteration due to symmetric LV hypertrophy.
  • This specific subgroup of HCM patients presents unique challenges in managing heart failure.
  • Current treatment options may be limited for these patients.

Purpose of the Study:

  • To detail the experience with transapical septal myectomy in patients with HCM and systolic cavity obliteration.
  • To evaluate the safety and efficacy of this surgical approach in enlarging LV volume and relieving cavity obliteration.
  • To assess early survival and functional outcomes in this patient cohort.

Main Methods:

  • Analysis of 38 patients with HCM and symmetric LV hypertrophy who underwent transapical septal myectomy between February 2001 and May 2021.
  • Evaluation of preoperative clinical status, including New York Heart Association (NYHA) class and exercise capacity.
  • Assessment of postoperative outcomes, including survival rates and functional improvement.

Main Results:

  • Most patients (84.2%) presented in NYHA class III/IV, with significantly reduced peak oxygen consumption and enlarged left atrial size.
  • Transapical septal myectomy was performed on all patients to increase LV cavity size.
  • No in-hospital mortality occurred; 1, 3, and 5-year survival rates were 100%, 92%, and 87%, respectively, with significant functional improvement reported in most patients.

Conclusions:

  • Transapical myectomy is a safe procedure for enlarging LV cavity volume in selected HCM patients.
  • The procedure demonstrates good early survival and functional outcomes.
  • It represents a valuable alternative to cardiac transplantation for HCM patients experiencing systolic cavity obliteration and progressive heart failure.
Abstract

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