Efficacy and Safety of Transapical Beating-Heart Myectomy in Patients Aged >65 Years With Hypertrophic Obstructive Cardiomyopathy

BACKGROUND: Although septal myectomy remains the gold standard for drug-refractory hypertrophic obstructive cardiomyopathy, its application in older adult patients (aged ≥65 years) has been limited by technical complexity. This retrospective cohort study evaluated the safety and efficacy of transapical beating-heart septal myectomy using a novel beating-heart myectomy device in older adult patients and compared perioperative outcomes with those in younger counterparts. METHODS: The study analyzed 101 consecutive patients with hypertrophic obstructive cardiomyopathy who underwent transapical beating-heart septal myectomy at a single tertiary center between April 2022 and July 2023, stratified into older adult (n = 34) and younger (n = 67) cohorts. All procedures used a minimally invasive beating-heart myectomy device system enabling cardiopulmonary bypass-free resection under continuous echocardiographic guidance. Multidisciplinary preoperative planning incorporated advanced imaging for precise resection strategy. Comparative analysis included procedural metrics, complications, and functional outcomes. RESULTS: The procedure achieved successful septal modification in most cases with favorable perioperative outcomes across both cohorts. Older adult patients demonstrated safety profiles equivalent to those in younger patients regarding critical care use and major complications. Significant hemodynamic improvements were observed in all patients, including marked reduction of left ventricular outflow obstruction and functional capacity enhancement. Postoperative morbidity rates remained low, with comparable rhythm-related and structural complications between the groups. Sustained clinical benefits were maintained at midterm follow-up in both populations. CONCLUSIONS: Transapical beating-heart septal myectomy demonstrates equivalent safety and efficacy in older adult and younger patients with hypertrophic obstructive cardiomyopathy, with preserved midterm functional outcomes. This minimally invasive approach eliminates cardiopulmonary bypass requirements while maintaining procedural precision, thus representing a viable alternative for high-risk geriatric patients.