Surgical myectomy reduced the mean pre-operative peak left ventricular outflow tract gradient from 63 mmHg to 15 mmHg, with an overall operative mortality of 0.38%.
Does surgical septal myectomy safely reduce LVOT gradient and improve symptoms in patients with hypertrophic cardiomyopathy?
Surgical septal myectomy is a highly effective and safe treatment for symptomatic hypertrophic cardiomyopathy, significantly reducing LVOT gradients with very low operative mortality at experienced centers.
Absolute Event Rate: 15% vs 63%
Abstract Background Hypertrophic cardiomyopathy (HCM) is a dynamic disease with a spectrum of clinical presentations ranging from incidental diagnosis to sudden cardiac death. Symptomatic patients are initially managed medically, and newer drugs are currently under investigation. Invasive therapy is needed for patients with intractable symptoms despite maximal medical therapy, and surgical myectomy is the gold standard treatment with better long-term survival. Results Over three decades, more than 4000 patients underwent surgical myectomy at the Cleveland Clinic. We conducted a detailed analysis of patients who underwent surgery for HCM between 2005 and 2015. Within this study period, 1549 patients underwent surgical myectomy. Their mean pre-operative peak left ventricular outflow tract (LVOT) gradient was 63 ± 4.6 mmHg, and it reduced to 15 ± 8.9 mmHg after surgery. Mean aortic cross-clamp time was 28 ± 10 min for isolated septal myectomy, and the mean mass of muscle resected was 8.1 ± 3.7 g. Complications include new incidences of pacemaker insertion in 4.2% of the patients, iatrogenic ventricular septal defects in two patients, and the overall operative mortality was 0.38%. Mean hospital stay was 6 days, and the majority of the patients are in New York Heart Association (NYHA) class I in their post-operative follow-up. Conclusion Septal myectomy is a curative therapy for most patients of HCM who are symptomatic despite maximal medical management. Clear understanding of individual septal anatomy and mechanisms of LVOT obstruction are key to successful surgical outcomes. Septal myectomy can be done safely with excellent long-term results.
Ananthanarayanan et al. (Sun,) conducted a review in Hypertrophic cardiomyopathy (n=1,549). Surgical myectomy vs. Pre-operative baseline was evaluated on Peak left ventricular outflow tract (LVOT) gradient. Surgical myectomy reduced the mean pre-operative peak left ventricular outflow tract gradient from 63 mmHg to 15 mmHg, with an overall operative mortality of 0.38%.