Septal myectomy

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]

Septal myectomy
Specialty	Cardiology, cardiothoracic surgery

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.^{[citation needed]}

Septal myectomy was established by Andrew G. Morrow in the 1960s.^[3]

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%

Survival (HCM-related death) Years With surgery Without surgery 1 99% 94% 5 98% 89% 10 95% 73%

Survival (sudden cardiac death) Years With surgery Without surgery 1 100% 97% 5 99% 93% 10 99% 89%

* Includes 0.8% operative mortality.

Comparison with alcohol ablation

Either alcohol ablation or myectomy offers substantial clinical improvement for patients with hypertrophic obstructive cardiomyopathy. One non-randomized comparison suggested that hemodynamic resolution of the obstruction and its sequelae are more complete with myectomy.^[5] Whether one or the other treatment is preferable for certain patient types is debated among cardiovascular scientists.^[6]