Septal myectomy explained
Septal myectomy is a cardiac surgery treatment for hypertrophic cardiomyopathy (HCM).[1] The open-heart surgery entails removing a portion of the septum that is obstructing the flow of blood from the left ventricle to the aorta.[2]
The most common alternatives to septal myectomies are treatment with medication (usually beta or calcium blockers) or non-surgical thinning of tissue with alcohol ablation. Ordinarily, septal myectomies are performed only after attempts at treatment with medication fail. The choice between septal myectomy and alcohol ablation is a complex medical decision.
Septal myectomy was established by Andrew G. Morrow in the 1960s.[3]
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Outcomes
Septal myectomy is associated with a low perioperative mortality and a high late survival rate. A study at the Mayo Clinic found surgical myectomy performed to relieve outflow obstruction and severe symptoms in HCM was associated with long-term survival equivalent to that of the general population, and superior to obstructive HCM without operation. The results are shown below:[4]
Survival (all-cause mortality) * | - ! Years | With surgery ! Without surgery | - | 1 | 98% | 90% | - | 5 | 96% | 79% | - | 10 | 83% | 61% | |
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| Survival (HCM-related death) | - ! Years | With surgery ! Without surgery | - | 1 | 99% | 94% | - | 5 | 98% | 89% | - | 10 | 95% | 73% | |
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| Survival (sudden cardiac death) | - ! Years | With surgery ! Without surgery | - | 1 | 100% | 97% | - | 5 | 99% | 93% | - | 10 | 99% | 89% | |
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Notes and References
- Book: Cui . Hao . Schaff . Hartzell V. . Raja . Shahzad G. . Cardiac Surgery: A Complete Guide . 2020 . Springer . Switzerland . 978-3-030-24176-6 . 735–748 . https://books.google.com/books?id=kcPPDwAAQBAJ&pg=PA735 . en . 80. Hypertrophic cardiomyopathy .
- Ralph-Edwards . Anthony . Vanderlaan . Rachel D. . Bajona . Pietro . Transaortic septal myectomy: techniques and pitfalls . Annals of Cardiothoracic Surgery . July 2017 . 6 . 4 . 410–415 . 10.21037/acs.2017.07.08 . 28944183 . 5602211 . 2225-319X . free .
- Web site: History of Changes for Study: NCT04603521 . clinicaltrials.gov . 30 October 2022 . en.
- Ommen S, Maron B, Olivotto I, Maron M, Cecchi F, Betocchi S, Gersh B, Ackerman M, McCully R, Dearani J, Schaff H, Danielson G, Tajik A, Nishimura R . Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy . J Am Coll Cardiol . 46 . 3 . 470–6 . 2005 . 16053960 . 10.1016/j.jacc.2005.02.090. 8546546 .
