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Extended septal myectomy for obstructive hypertrophic cardiomyopathy and its impact on mitral valve function

Antonio Lio1, Mariangela D'Ovidio2, Ilaria Chirichilli1

  • 1Department of Cardiac Surgery and Transplantation, S. Camillo Hospital.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|January 22, 2024
PubMed

Insights

Extended septal myectomy effectively treats hypertrophic obstructive cardiomyopathy (HOCM) and associated mitral valve issues. Concomitant mitral valve surgery is rarely needed, as adequate myectomy addresses the underlying pathophysiology in most patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) often necessitates surgical intervention.
  • Systolic anterior motion (SAM) of the mitral valve leading to secondary regurgitation occurs in 30-60% of HOCM patients.
  • Septal myectomy is the gold standard surgical treatment for HOCM.

Purpose of the Study:

  • To evaluate the outcomes of extended septal myectomy in HOCM patients.
  • To assess the necessity and impact of concomitant mitral valve procedures during extended septal myectomy.
  • To analyze long-term survival, rehospitalization rates, and need for pacemaker implantation.

Main Methods:

  • Retrospective study of 84 patients undergoing septal myectomy (SM) from 2008 to 2022.
  • Surgical technique based on the 'extended myectomy' concept.
  • Follow-up included survival, heart failure/mitral valve disease admissions, reoperations, and pacemaker implantation.

Main Results:

  • Mean age was 61 years; 8% underwent concomitant mitral valve surgery, primarily for intrinsic valve disease.
  • In-hospital mortality was 5%; 5% had residual moderate or severe mitral regurgitation at discharge.
  • Twelve-year survival was 78%; freedom from cardiac reoperations was 100%.

Conclusions:

  • Extended septal myectomy yields good outcomes for HOCM.
  • Concomitant mitral valve surgery is infrequently required and typically only for intrinsic mitral valve disease.
  • Adequate septal myectomy effectively addresses the pathophysiology of HOCM and associated SAM-induced regurgitation.
Abstract

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