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Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC
Barry J Maron1, Joseph A Dearani2, Nicholas G Smedira3
1Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA.
The American Journal of Cardiology
|August 14, 2022
Summary
Surgical myectomy is a safe and effective treatment for hypertrophic cardiomyopathy, relieving symptoms and improving survival. This procedure offers a high benefit with low risk for patients with obstructive symptoms.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Hypertrophic cardiomyopathy (HCM) with drug-refractory symptoms due to left ventricular (LV) outflow obstruction is primarily treated with surgical myectomy.
- Over 50 years of experience demonstrate surgery's efficacy in reversing heart failure, normalizing LV pressures, and preserving systolic function.
Purpose of the Study:
- To review the long-term outcomes and current status of surgical myectomy for obstructive HCM.
- To highlight the safety and effectiveness of myectomy in experienced centers.
Main Methods:
- Analysis of data from a consortium of 10 international myectomy centers, reporting on approximately 11,000 operations.
- Review of historical trends and perioperative outcomes, including mortality rates.
Main Results:
- Perioperative mortality for myectomy has decreased to 0.6% in experienced centers, making it a safe open-heart procedure.
- Symptom relief (≥ 1 NYHA class) is achieved in over 90% of patients, with most returning to normal daily activities and experiencing long-term survival benefits.
- Concomitant Cox-Maze procedures can reduce atrial fibrillation episodes.
Conclusions:
- Surgical myectomy remains a guideline-based, high-benefit, low-risk option for adults and children with obstructive HCM.
- Despite historical challenges and alternative therapies, myectomy continues to be a preferred treatment in high-volume clinical settings.
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