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Outcomes of Surgical Myectomy and Mitral Valve Repair for Hypertrophic Cardiomyopathy With vs Without Marked Septal

Kenza Rahmouni1, Hugo M N Issa1,2, Omar Toubar3

  • 1Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.

CJC Open
|July 23, 2025
PubMed

Insights

Septal myectomy combined with mitral valve intervention is safe and effective for relieving left ventricular outflow tract obstruction in hypertrophic cardiomyopathy (HCM) patients. This approach benefits even those without severe septal thickening.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Hypertrophic cardiomyopathy (HCM) can cause debilitating left ventricular outflow tract (LVOT) obstruction.
  • Septal myectomy is a primary surgical treatment for obstructive HCM.
  • The role of concomitant mitral valve interventions in HCM septal myectomy requires further clinical outcome analysis.

Purpose of the Study:

  • To evaluate clinical and echocardiographic outcomes of septal myectomy with or without mitral valve interventions in HCM patients.
  • To assess the safety and efficacy of combined procedures across varying degrees of septal hypertrophy.
  • To analyze the impact on LVOT obstruction and patient mortality.

Main Methods:

  • Retrospective analysis of 61 consecutive HCM patients undergoing transaortic septal myectomy (October 2019-March 2024).
  • Inclusion of patients with or without subvalvular mitral apparatus intervention.
  • Preoperative and postoperative assessment using transesophageal echocardiography and cardiac magnetic resonance imaging to measure gradients and evaluate mitral valve morphology.

Main Results:

  • 32 patients (52.5%) had concomitant mitral valve interventions (papillary muscle realignment, aberrant chordae resection).
  • Significant reduction in peak LVOT gradients at rest (47.8 to 8.8 mm Hg) and under stress (114.2 to 17.6 mm Hg) (P < 0.001).
  • Low 30-day (1.6%) and 2-year (3.3%) mortality; no postoperative ventricular septal defects.

Conclusions:

  • Septal myectomy with mitral valve apparatus intervention is safe and effective for symptomatic HCM patients.
  • Excellent relief of LVOT obstruction is achieved, even in patients with mild septal hypertrophy (≤ 15 mm).
  • Combined approach offers a viable solution for complex HCM cases requiring LVOT gradient reduction.
Abstract

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