A Contemporary European Experience With Surgical Septal Myectomy in Hypertrophic Cardiomyopathy

Study Questions:

What are the challenges and results in developing a new myectomy program for hypertrophy cardiomyopathy (HCM) in a center without previous experience with this procedure?

Methods:

The authors reported their experience with 124 consecutive patients with symptomatic obstructive HCM who underwent myectomy at a single European center between 1996 and 2010.

Results:

Myectomy was performed in 124 patients, with the majority of procedures (109, 88%) being performed in the last 5 years of the study period. The median follow-up was 20.3 months. There was one operative death (0.8%). The cumulative incidence of HCM-related death after myectomy was 0.8% at 1 year, 3.3% at 5 years, and 11.2% at 10 years. The left ventricular (LV) outflow gradient decreased from a mean of 95 ± 36 mm Hg before surgery to 12 ± 6 mm Hg at follow-up (p < 0.001), with none of the patients having a significant residual LV outflow gradient. There were 97 patients who had New York Heart Association functional class III-IV before surgery and of these, 93 (96%) were in class I-II at follow-up.

Conclusions:

The authors demonstrated the successful development of a myectomy program, with excellent clinical results.

Perspective:

The preferred treatment of symptomatic HCM is surgical myectomy due to the excellent long-term results with this procedure compared with an increase in the long-term risk of death with alcohol ablation. Myectomy is an uncommon procedure, but in centers that perform this surgery on a regular basis, the short- and long-term results are excellent. The authors in this study demonstrate the feasibility of creating a successful myectomy program based on a close collaboration between multiple cardiology centers that take care of patients with HCM, and a cardiac surgery center that had an interest and the expertise to support such a program. This experience should serve as a model for other countries or regions that seek to create similar centers for care of patients with HCM.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure

Keywords: Heart Diseases, Incidence, Follow-Up Studies, Heart Septum, Ventricular Outflow Obstruction, Cardiology, Cardiomyopathies, Heart Failure, Cardiac Surgical Procedures, New York, Hypertrophy


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