Surgery for hypertrophic obstructive cardiomyopathy: the European perspective.

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical History

Background:

• Hypertrophic cardiomyopathy (HCM) is a significant cardiac condition with a complex treatment landscape in Europe.
• Surgical septal myectomy, historically a key intervention, faces challenges in widespread adoption across the continent.
• The rise of alcohol septal ablation (ASA) and novel cardiac myosin inhibitors (CMIs) has impacted surgical expertise and availability.

Purpose of the Study:

• To review the historical evolution of surgical treatment for obstructive HCM in Europe.
• To assess the current status and disparities in septal myectomy programs across European centers.
• To evaluate the clinical and economic implications of surgical versus pharmacological management of HCM.

Main Methods:

• Analysis of historical data and trends in HCM surgical interventions in Europe.
• Direct correspondence with active European cardiac surgeons to gather insights on myectomy programs.
• Collection and review of institutional data on septal myectomy volumes and access.

Main Results:

• Septal myectomy adoption is uneven across Europe, with only three centers performing over 25 procedures annually.
• Significant disparities exist in access, procedural volume, and national coordination for HCM surgery.
• Contemporary pharmacological treatments and ASA have contributed to a decline in surgical expertise.

Conclusions:

• There is an urgent need for structured training programs and procedural standardization for septal myectomy in Europe.
• Broader recognition of septal myectomy as a definitive and cost-effective treatment for obstructive HCM is crucial.
• Addressing disparities in access and promoting surgical expertise can improve outcomes for HCM patients.