Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience

Abstract

Conclusions: Septal myectomy effectively and definitively relieves LVOT obstruction and cardiac symptoms in patients with obstructive HCM. In experienced centers, early mortality for isolated septal myectomy is less than 1%, and overall results are excellent and continue to improve in the current era.

Mid‐term outcomes of simultaneous coronary artery bypass graft surgery and septal myectomy in patients with hypertrophic obstructive cardiomyopathy: A case‐controlled study

“…In addition, this is inconsistent with the previous study that the risk of hospital death after isolated septal myectomy for obstructive HCM is <1%. This inconsistency could be attributed to the technological advances in surgery over the last few years and the relatively small number of patients who were matched with HOCM and CAD . However, we found that a significantly higher number of postoperative mid‐term cardiovascular‐related deaths and adverse cardiovascular events was observed in patients with HOCM complicated with CAD than in those without CAD.…”

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: a case with a very high left ventricular outflow tract gradient

“…However, literature tends to support better long-term symptom relief in those patients who undergo septal myectomy, lower rate of complications, and immediate results over ASA with an immediate reduction in LVOT gradient. Also, patients with veru high LVOT gradients are considered poor candidates for ASA 5 those patients with a very high LVOT gradient. According to the 2014 European Society of Cardiology (ESC) Guidelines, surgical myectomy is recommended in patients with a resting or maximum provoked LVOT gradient of ≥50 mm Hg, who are in NYHA functional class III-IV, despite maximum tolerated medical therapy (class of recommendation and level of evidence IB).…”

What is the role of apical ventriculotomy in children and young adults with hypertrophic cardiomyopathy?

“…Patients with midventricular obstruction that is not related to systolic anterior motion (SAM) or patients with small LV cavities that are not amenable to medical therapy may be best served by surgical intervention, notably surgical myectomy . However, surgical myectomy via a transaortic approach alone often is insufficient in patients with midventricular gradients or small apical cavities.…”

“…transaortic approach for basal LVOT obstruction, for which excellent outcomes have been reported previously in adult and pediatric patients. [7][8][9][10] However, for a small subset of patients, the transaortic approach to myectomy is insufficient for adequate relief of midventricular obstruction because of poor exposure due to a small aortic annulus. In addition, a small number of patients will have heart failure-related symptoms due to "below normal" LV stroke volume.…”