Septal myectomy
Septal myectomy is a cardiac surgery treatment for hypertrophic cardiomyopathy (HCM). The surgery entails removing a portion of the septum that is obstructing the flow of blood from the left ventricle to the aorta. Septal myectomies have been successfully performed for more than 25 years. The alternatives to septal myectomies are treatment with medication (usually beta or calcium blockers) or non-surgical removal 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.
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:[1]
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.[2] Whether one or the other treatment is preferable for certain patient types is debated among cardiovascular scientists.[3]
References
- ↑ 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 (2005). "Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy". J Am Coll Cardiol 46 (3): 470–6. doi:10.1016/j.jacc.2005.02.090. PMID 16053960.
- ↑ Ralph-Edwards A, Woo A, McCrindle B, Shapero J, Schwartz L, Rakowski H, Wigle E, Williams W (2005). "Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score". J Thorac Cardiovasc Surg 129 (2): 351–8. doi:10.1016/j.jtcvs.2004.08.047. PMID 15678046.
- ↑ Heldman AW, Wu KC, Abraham TP, Cameron DE (2007). "Myectomy or alcohol septal ablation surgery and percutaneous intervention go another round". J. Am. Coll. Cardiol. 49 (3): 358–60. doi:10.1016/j.jacc.2006.10.029. PMID 17239718.
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