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Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy
Published on: September 9, 2020
Treatment Strategies for Hypertrophic Cardiomyopathy: Surgical
Hartzell V Schaff1, Fernando M Juarez-Casso1
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Septal myectomy effectively treats obstructive hypertrophic cardiomyopathy (HCM) when medication fails. This surgical reduction of the heart septum offers significant symptom relief and functional improvement with low risks in experienced hands.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Disease
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) is a significant cause of heart failure.
- Medical management is insufficient for many patients with obstructive HCM.
- Septal reduction surgery is a key therapeutic option for refractory cases.
Purpose of the Study:
- To review the surgical management of obstructive hypertrophic cardiomyopathy (HCM).
- To detail the operative techniques and outcomes of septal myectomy.
- To highlight the tailored approach based on patient-specific pathophysiology and septal morphology.
Main Methods:
- Extended transaortic myectomy for isolated subaortic obstruction.
- Transapical myectomy for long/midventricular obstruction and apical hypertrophy.
- Surgical approach individualized to patient anatomy and disease presentation.
Main Results:
- Septal myectomy yields excellent postoperative symptom relief and functional improvement.
- Low rates of operative morbidity and mortality are reported from experienced centers.
- Effective treatment for severe symptomatic diastolic heart failure due to apical hypertrophy.
Conclusions:
- Septal myectomy is a safe and effective treatment for obstructive HCM.
- Tailored surgical techniques ensure optimal outcomes for diverse HCM presentations.
- This procedure significantly enhances quality of life for affected patients.
Abstract:
Septal myectomy is a well-established procedure for septal reduction in patients with obstructive hypertrophic cardiomyopathy (HCM) who have not responded to medical treatment. The surgical approach is tailored to the unique pathophysiology and septal morphology of the patient. Extended transaortic myectomy is the standard procedure for patients with isolated subaortic obstruction, the most common type of HCM. However, transapical myectomy is a useful adjunct for patients with long or midventricular obstruction and is our preferred technique for ventricular enlargement in patients with severe symptomatic diastolic heart failure because of extensive apical hypertrophy. Septal myectomy provides excellent postoperative outcomes as regards symptom relief and functional improvement, and operative morbidity and mortality rates are low in experienced centers. This article summarizes our current surgical management of patients with HCM and details operative methods and outcomes.
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