Transaortic Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy

Abstract

Transaortic extended septal myectomy is the best treatment option for patients with obstructive hypertrophic cardiomyopathy whose symptoms are refractory to medical management. In this article, we describe our operative technique of transaortic septal myectomy, which relieves subaortic left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve associated with hypertrophic cardiomyopathy. In experienced centers, surgical outcomes are excellent (operative mortality <1%) and long-term symptomatic relief is achieved in the majority of patients. Operative Techniques in Thoracic and Cardiovasculary Surgery 22:200À215

Management of the mitral valve in patients with obstructive hypertrophic cardiomyopathy

“…We have previously described our surgical technique of septal myectomy in detail [16]. In brief, following a median sternotomy, we measure gradients between the aorta and left ventricle directly using needle manometry (Fig.…”

“…2017;22 [4]:200-215. Copyright Elsevier Inc.) [16] [17]. In our experience, the most common of reoperation after myectomy is inadequate length of initial septal excision, rather than inadequate depth of septal excision [18].…”

“…2017;22 [4]:200-215. Copyright Elsevier Inc.) [16] these cases, direct mitral valve surgery is required in addition to extended myectomy. We concomitant mitral valve repair rather than replacement, as long-term results are better following repair.…”

“…These authors speculate that the patch may serve to stiffen the leaflet, making it less likely to buckle in the presence of Venturi or flow drag forces [21]. In a study of 29 patients who underwent combined anterior mitral leaflet extension with myectomy, clinical results were satisfactory with improvement in functional status, reduction of left ventricular outflow tract [16] obstruction, and attenuation of MR and SAM of the mitral valve at 3.4-year follow-up [23].…”

“…For example, among patients reported to the STS database, operative mortality was 2.8% for myectomy combined with a mitral valve procedure compared with 1.6% for septal myectomy alone (p = 0.046). For patients with SAM-mediated MR, we prefer isolated septal myectomy over [16] the aforementioned combined procedures of myectomy and concomitant mitral valve repair or replacement. In a review almost 1500 patients who underwent septal myectomy for obstructive HCM at Mayo Clinic (92% isolated myectomy, and 8% myectomy with mitral valve operation for intrinsic MV disease or residual gradients), Nguyen and coauthors [33] demonstrated that greater than moderate MR was present in only 1% following septal myectomy.…”