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Efficacy and Safety of Transapical Beating-Heart Myectomy in Patients Aged >65 Years With Hypertrophic Obstructive
Xiantao Ma1, Cai Cheng2, Chenhe Li2
1Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Transapical beating-heart septal myectomy is safe and effective for older adults with hypertrophic obstructive cardiomyopathy. This minimally invasive procedure offers comparable outcomes to younger patients, improving heart function without cardiopulmonary bypass.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Septal myectomy is the standard for drug-refractory hypertrophic obstructive cardiomyopathy (HOCM).
- Older adults (≥65 years) face challenges due to technical complexity of traditional myectomy.
- Evaluating a novel transapical beating-heart approach in this demographic is crucial.
Purpose of the Study:
- To assess the safety and efficacy of transapical beating-heart septal myectomy in older adults (≥65 years).
- To compare perioperative outcomes between older adult and younger HOCM patients.
- To evaluate the feasibility of a minimally invasive, cardiopulmonary bypass-free technique.
Main Methods:
- Retrospective cohort study of 101 HOCM patients (34 older adults, 67 younger).
- All underwent transapical beating-heart septal myectomy using a novel device under echocardiographic guidance.
- Comparative analysis of procedural metrics, complications, and functional outcomes.
Main Results:
- Successful septal modification with favorable outcomes in both age groups.
- Older adults showed equivalent safety profiles to younger patients regarding critical care and major complications.
- Significant hemodynamic improvements, reduced left ventricular outflow obstruction, and enhanced functional capacity were observed in all patients.
Conclusions:
- Transapical beating-heart septal myectomy is safe and effective in older adults with HOCM, matching younger patient outcomes.
- This minimally invasive technique preserves midterm functional benefits without cardiopulmonary bypass.
- It offers a viable alternative for high-risk geriatric patients with HOCM.
Background:
Although septal myectomy remains the gold standard for drug-refractory hypertrophic obstructive cardiomyopathy, its application in older adult patients (aged ≥65 years) has been limited by technical complexity. This retrospective cohort study evaluated the safety and efficacy of transapical beating-heart septal myectomy using a novel beating-heart myectomy device in older adult patients and compared perioperative outcomes with those in younger counterparts.
Methods:
The study analyzed 101 consecutive patients with hypertrophic obstructive cardiomyopathy who underwent transapical beating-heart septal myectomy at a single tertiary center between April 2022 and July 2023, stratified into older adult (n = 34) and younger (n = 67) cohorts. All procedures used a minimally invasive beating-heart myectomy device system enabling cardiopulmonary bypass-free resection under continuous echocardiographic guidance. Multidisciplinary preoperative planning incorporated advanced imaging for precise resection strategy. Comparative analysis included procedural metrics, complications, and functional outcomes.
Results:
The procedure achieved successful septal modification in most cases with favorable perioperative outcomes across both cohorts. Older adult patients demonstrated safety profiles equivalent to those in younger patients regarding critical care use and major complications. Significant hemodynamic improvements were observed in all patients, including marked reduction of left ventricular outflow obstruction and functional capacity enhancement. Postoperative morbidity rates remained low, with comparable rhythm-related and structural complications between the groups. Sustained clinical benefits were maintained at midterm follow-up in both populations.
Conclusions:
Transapical beating-heart septal myectomy demonstrates equivalent safety and efficacy in older adult and younger patients with hypertrophic obstructive cardiomyopathy, with preserved midterm functional outcomes. This minimally invasive approach eliminates cardiopulmonary bypass requirements while maintaining procedural precision, thus representing a viable alternative for high-risk geriatric patients.
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