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Myectomy with secondary chordal resection in hypertrophic obstructive cardiomyopathy: the mid-term outcomes

Zhuheng Wu1, Zedong He1, Lin Xie1

  • 1Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.

Journal of Cardiothoracic Surgery
|May 5, 2026
PubMed

Insights

Septal myectomy with secondary chordal resection (SM-SCR) shows comparable mid-term outcomes for hypertrophic obstructive cardiomyopathy (HOCM) patients regardless of septal hypertrophy severity. Further research is needed to confirm these findings in larger, longer-term studies.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Research

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents challenges in surgical management.
  • The effectiveness of septal myectomy with secondary chordal resection (SM-SCR) in HOCM patients with varying septal hypertrophy severity is not well-defined.
  • Understanding differential outcomes based on hypertrophy severity is crucial for personalized treatment strategies.

Purpose of the Study:

  • To evaluate and compare the postoperative outcomes of SM-SCR in HOCM patients with significant versus mild septal hypertrophy.
  • To assess the relief of left ventricular outflow tract (LVOT) obstruction and the incidence of recurrent mitral regurgitation (MR).
  • To identify potential predictors for recurrent MR after SM-SCR.

Main Methods:

  • A single-center retrospective cohort study including a nested case-control analysis.
  • 88 HOCM patients who underwent SM-SCR between 2014 and 2023 were retrospectively analyzed.
  • Patients were stratified into significant hypertrophy (SH) and mild hypertrophy (MH) groups based on septal thickness; LVOT gradients and MR recurrence were primary endpoints.

Main Results:

  • At a median follow-up of 54 months, both LVOT gradients and interventricular septum (IVS) thickness were comparable between the SH and MH groups after adjusting for covariates.
  • The risk of recurrent mitral regurgitation (MR) was similar between the groups (7.9% vs. 8.0%).
  • No significant predictors for recurrent MR were identified in this cohort.

Conclusions:

  • Mid-term outcomes following SM-SCR are comparable for HOCM patients with differing degrees of septal hypertrophy.
  • The surgical approach appears effective in managing LVOT obstruction irrespective of initial septal thickness.
  • Larger studies with extended follow-up are recommended to further validate these findings.
Abstract

Keywords:
Mitral regurgitationObstructive hypertrophic cardiomyopathySecondary chordal resectionSeptal myectomy

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