Surgery Insight: septal myectomy for obstructive hypertrophic cardiomyopathy[mdash]the Mayo Clinic experience | Article

Nature Clinical Practice Cardiovascular Medicine Surgery Insight: septal myectomy for obstructive hypertrophic cardiomyopathy[mdash]the Mayo Clinic experience Article

Nature Clinical Practice Cardiovascular Medicine (2007) 4, 503-512
Received 31 August 2006 Accepted 11 May 2007

Surgery Insight: septal myectomy for obstructive hypertrophic cardiomyopathy—the Mayo Clinic experience

Joseph A Dearani*, Steve R Ommen, Bernard J Gersh, Hartzell V Schaff and Gordon K Danielson About the authors

Correspondence *Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA Email dearani.joseph@mayo.edu

Summary

Septal myectomy has been the gold standard treatment for the relief left ventricular outflow tract obstruction and cardiac symptoms in both adults and children with obstructive hypertrophic cardiomyopathy. In almost all circumstances, abnormalities of the mitral valve and subvalvar mitral apparatus can be managed without the need for mitral valve replacement, and other cardiac lesions can be repaired simultaneously.

In the current era, the operative mortality for isolated septal myectomy at an experienced center is low in both children and adults (approximately 1%).

Excellent late results with myectomy are gratifying: 90% of patients improve by at least one NYHA class, and improvements persist in most individuals on late follow-up.

Late survival in patients with obstructive hypertrophic cardiomyopathy who undergo myectomy exceeds that of patients who do not receive surgical treatment and, in addition, myectomy may be associated with reduced long-term risk of sudden cardiac death.

These results should serve as a basis for comparison with newer nonsurgical treatment regimens.

Key points

1. 
   
   Septal myectomy relieves left ventricular outflow tract obstruction and cardiac symptoms effectively in both adults and children with obstructive hypertrophic cardiomyopathy
   
   Abnormalities of the mitral valve and subvalvar mitral apparatus can be addressed without the need for mitral valve replacement in almost all circumstances, and other cardiac lesions can be repaired at the time of myectomy
   
   In experienced centers, the operative mortality and morbidity for isolated septal myectomy in both children and adults is low (approximately 1%) and continues to improve
   
   Symptomatic improvement with myectomy is gratifying: 90% of patients improve by at least one NYHA class, and most remain improved on late follow-up
   
   Late survival is better in patients with obstructive hypertrophic cardiomyopathy who receive surgery than in those who do not