Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Abstract

Background We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. Results The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02–11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. Conclusions The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.

Transapical beating-heart septal myectomy for hypertrophic cardiomyopathy with latent obstruction

“…Therefore, the resection should be performed cautiously in patients with mild septal hypertrophy. In a recent study of 583 patients receiving SM, 9 (1.5%) had the occurrence of ventricular septal perforation [ 29 ], which was a little higher than our study. In addition, LV apical tear occurred in 1 (0.8%) patient at the end of the TA-BSM procedure, the rate of which was similar to previous studies [ 9 , 29 ].…”

“…In a recent study of 583 patients receiving SM, 9 (1.5%) had the occurrence of ventricular septal perforation [ 29 ], which was a little higher than our study. In addition, LV apical tear occurred in 1 (0.8%) patient at the end of the TA-BSM procedure, the rate of which was similar to previous studies [ 9 , 29 ]. We successfully managed this rare complication via bailout surgery to repair the tear via median sternotomy, with the use of CPB.…”

Transapical Approach to Septal Myectomy for Hypertrophic Cardiomyopathy

“…We have experience of performing over 500 septal myectomies [15] and many concomitant procedures [16]; however, we do not have expertise in transapical myectomy. We perform up to 100 transaortic procedures annually; however, every mildly symptomatic patient with apical HCM is considered for pharmacological management owing to the presumed benign prognosis.…”