Surgical treatment of hypertrophic obstructive cardiomyopathy

The rationale for surgical treatment of hypertrophic obstructive cardiomyopathy is based on the assumption that dynamical obstruction is mainly caused by a reduction in the left ventricular outflow tract cross-sectional area due to bulging septal myocardial tissue. In this sense, classical myotomy-myectomy is the `gold standard' therapy for patients with severely symptomatic hypertrophic obstructive cardiomyopathy. In my own experience with extended myectomy, more than three-quarters of all long-term survivors are in functional class I or II (New York Heart Association) and overall survival after 18 years (mean follow up 8.1 years) was 68%, with a linearized mortality rate of 1.9% per patient-year. Notably, there was no case of sudden cardiac death during follow up, leading to the assumption that relief from dynamical obstruction is most effective in the prevention of sudden cardiac death in these patients.