Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy: Results of Extended Septal Myectomy in 24 Patients

Hypertrophic obstructive cardiomyopathy generally responds well to medical therapy. However, about 5% of patients require invasive procedures. There is no clear consensus on the invasive treatment for these patients. Therefore, we aimed to analyze and present the results of our experience with surgical treatment between 2014 and 2024.

A total of 24 patients who underwent extended septal myectomy were retrospectively analyzed. Preoperative demographic and comorbid factors were assessed. The patients underwent echocardiography 12 months after surgery. Preoperative and postoperative functional capacity in the first year and the results of the echocardiographic examinations were analyzed.

Nineteen (79.1%) patients were in New York Heart Association (NYHA) class III-IV before surgery, while none were in NYHA class III-IV after surgery (p < 0.001). The septal thickness (mm) was 19.7 ± 2.34 before surgery compared to 10.9 ± 1.38 after surgery; the left ventricular outflow tract gradient (mmHg) was 90.6 ± 15.4 before surgery compared to 21.3 ± 4.48 after surgery, and the decrease was statistically significant (p < 0.001). No statistically significant differences were found between left ventricular ejection fraction (%), left ventricular end-diastolic diameter (mm), left ventricular end-systolic diameter (mm) and mean pulmonary artery pressure (mmHg) values before and after surgery.

Extended septal myectomy performed after evaluation by the heart team for the treatment of hypertrophic obstructive cardiomyopathy led to satisfactory results in suitable patients. A surgical treatment option could be considered in symptomatic patients despite optimal medical therapy.