Importance of surgical expertise in septal myectomy for obstructive hypertrophic cardiomyopathy

Yu, Sarah N; Nakanishi, Koki; Ginns, Jonathan; Salna, Michael; Shimada, Yuichi J.; Polanco, Antonio; Chiang, Yu-Ting; Weiner, Shepard D.; Takayama, Hiroo

doi:10.1007/s11748-020-01320-7

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…This is due to a higher chance of requiring a pacemaker or re-interventions after alcohol septal ablation. [29][30][31] Most of the current data on these interventions are limited to developed countries, with inadequate data on the status of these 32 and the lack of sufficient data on long-term outcomes interventions.…”

Section: Discussionmentioning

confidence: 99%

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Ayati,

Khoshfetrat,

Davoodi

et al. 2024

Health Science Reports

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BackgroundHypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life‐threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long‐term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries.MethodsThis was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in‐hospital and long‐term outcomes were reported and compared between the three groups.ResultsA total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty‐six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8‐year follow‐up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups.ConclusionIsolated septal myectomy showed better long‐term survival rates and can correct HCM‐related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM.

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Section: Discussionmentioning

confidence: 99%

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Ayati,

Khoshfetrat,

Davoodi

et al. 2024

Health Science Reports

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“…Surgical myectomy may need to be extended to a mid-ventricular depth and mitral valve repair or replacement may be necessary. 6 Also, septal thickness can be inhomogeneous in the preferred area of the myectomy, requiring the muscular resection to be shifted anteriorly or posteriorly from its usual position to avoid the possibility of an iatrogenic ventricular septal defect. Such LVOT abnormalities, recognized as part of HOCM, make it less likely that the myocardial infarction induced by percutaneous alcohol septal ablation (fixed in its location by distribution of the first septal perforator coronary artery) will achieve the desired hemodynamic result in certain individual patients.…”

Section: Cmr Cardiologist/radiologistmentioning

confidence: 99%

“…Second, elongated MV leaflets, identifiable by CMR in many young HCM patients, often displace the point of obstruction more distally than usual. Surgical myectomy may need to be extended to a mid‐ventricular depth and mitral valve repair or replacement may be necessary 6 . Also, septal thickness can be inhomogeneous in the preferred area of the myectomy, requiring the muscular resection to be shifted anteriorly or posteriorly from its usual position to avoid the possibility of an iatrogenic ventricular septal defect.…”

Section: Bodymentioning

confidence: 99%

Role of cardiac magnetic resonance (CMR) in planning ventricular septal myomectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM)

Alenezi

Alajmi

Agarwal

et al. 2022

Journal of Cardiac Surgery

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Septal myectomy is currently the gold standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure needs to be tailored and performed in a personalized fashion, taking into consideration the anatomic and physiologic heterogeneity of this disease. The extent and location of surgical myectomy will depend on the location of the hypertrophy, with the goal of widening the outflow tract and improve the function of the mitral valve. CMR helps to identify hypertrophy not well visualized by TTE, providing more accurate wall thickness measurements and differentiating HOCM from other causes of LV hypertrophy. CMR also helps identify an abnormal attachment of papillary muscle to the MV or to the septal myocardium and mitral valve pathology. A collaborative approach with cardiac surgeons, radiologists and cardiologists will optimize preoperative planning to improve the success for surgical myectomy.

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“…10 In addition, our previous study revealed that patients who underwent septal myectomy by a dedicated myectomy surgeon had significantly lower rates of concomitant mitral valve replacement and better clinical outcomes than those who were operated by a nondedicated myectomy surgeon. 11 Attaining adequate dimensions of resection in septal myectomy is technically challenging and requires extensive surgical expertise afforded by only high-volume experienced surgeons and centers. Although the general principles of septal myectomy are well described in the literature, the operation must invariably be tailored to each specific patient, taking into consideration their anatomy of hypertrophic septal myocardium and abnormal mitral valve.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Septal Band: How Imaging and 3-Dimensional Printing Guides Septal Myectomy

Anzai

Hayashi

Nguyen

et al. 2022

Innovations�(Phila)

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Importance of surgical expertise in septal myectomy for obstructive hypertrophic cardiomyopathy

Cited by 5 publications

References 22 publications

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Role of cardiac magnetic resonance (CMR) in planning ventricular septal myomectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM)

The Septal Band: How Imaging and 3-Dimensional Printing Guides Septal Myectomy

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