肥大型閉塞性心筋症に対する拡大中隔切除術 - いまだにゴールドスタンダードか？

Surgical septal myectomy remains the definitive treatment for symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM), with symptomatic improvement in over 90% of patients, sustained relief of left ventricular outflow tract (LVOT) obstruction, and remarkably low operative mortality rates - less than 0.5% at experienced centers. The operation addresses septal hypertrophy and dynamic systolic anterior motion-mediated mitral valve (MV) regurgitation. Most patients require only isolated septectomy, and adjunctive MV procedures are reserved for patients with additional intrinsic MV pathology. Institutional volume strongly correlates with outcomes of transaortic septal myectomy; centers performing fewer than one myectomy annually have significantly higher rates of MV replacement and complications compared to high-volume institutions. Septal myectomy restores life expectancy to levels comparable with age- and sex-matched populations, and often exceeds outcomes seen with alcohol septal ablation, particularly in patients with marked hypertrophy or complex anatomy. Although novel pharmacologic therapies are emerging, surgical myectomy remains the gold-standard therapy for patients with refractory symptoms due to dynamic LVOT obstruction. Continued refinement of techniques and patient selection has solidified its role as one of the safest and most effective open-heart operations available.