Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Abstract

Our understanding of hypertrophic cardiomyopathy (HCM) as a disease entity has increased dramatically over the last half century. There has been a concerted effort by several surgical groups to develop operative techniques to relieve left ventricular outflow tract (LVOT) obstruction and alleviate symptoms. This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. In addition, we introduce newer methods for myectomy that have expanded the role of surgery in patients with various forms of HCM.

Cardiac implantable electronic device placement following alcohol septal ablation for hypertrophic cardiomyopathy in the United States

“…The median [IQR] time to readmission was also similar between groups (12.5 [5,23] and 8 [3,18] days, respectively; p = .09). Of those who did not undergo CIED placement during their index hospitalization, only 17 (1.3%) additional patients received a device during the subsequent 30 days.…”

“…1,2 Patients with obstructive HCM are typically considered for surgical myectomy or catheterbased alcohol septal ablation (ASA), when symptomatic, with a resting or provoked left ventricular outflow tract gradient of ≥50 mmHg, and when symptoms are refractory to optimal medical therapy. 3 Annual rates of septal myectomy and ASA in the United States have been estimated at 1.60 and 2.49 procedures per million people, respectively. 4 Although there are no randomized data comparing these two modalities, large systematic reviews suggest that symptom relief, sudden cardiac death (SCD) rates and long-term mortality are similar after ASA and myectomy.…”

Hypertrophic cardiomyopathy: current state of the problem

“…В этом случае хирурги выполняют трансапикальную левую вентрикулотомию в качестве доступа для МЭ гипертрофированной МЖП, свободной стенки ЛЖ и резекции папиллярных мышц [30]. В случае сочетания субаортальной и среднежелудочковой обструкции ЛЖ можно использовать комбинированный (трансаортальный и трансапикальный) доступ [31]. Чреспредсердный трансмитральный доступ, требующий для выполнения МЭ отсечения передней створки МК с последующей ее фиксацией, чаще используют у детей из-за невозможности произвести вмешательство через узкое ввиду возраста фиброзное кольцо аортального клапана [31].…”

Surgical myectomy: Rationale and personalized technique

“…However, it is well known now that in HCM patients with mitral regurgitation secondary to SAM, the mitral regurgitation resolves by myectomy alone in >95% of patients. Messmer introduced the concept of an extended septal myectomy for obstructive HCM in 1994 by having additional resection carried out the junction between septum and both the lateral wall and posterior wall at the midventricular level 42 .…”