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Table 1.  

Surgical Techniques For Outflow Obstruction in Patients With Hypertrophic Cardiomyopathy

Surgery Insight: Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy -- The Mayo Clinic Experience

Authors: Joseph A. Dearani, MD ; Steve R. Ommen, MD ; Bernard J. Gersh, MD ; Hartzell V. Schaff, MD ; Gordon K. Danielson, MDFaculty and Disclosures


Summary and Introduction


Septal myectomy has been the gold standard treatment for the relief left ventricular outflow tract obstruction and cardiac symptoms in both adults and children with obstructive hypertrophic cardiomyopathy. In almost all circumstances, abnormalities of the mitral valve and subvalvar mitral apparatus can be managed without the need for mitral valve replacement, and other cardiac lesions can be repaired simultaneously. In the current era, the operative mortality for isolated septal myectomy at an experienced center is low in both children and adults (approximately 1%). Excellent late results with myectomy are gratifying: 90% of patients improve by at least one NYHA class, and improvements persist in most individuals on late follow-up. Late survival in patients with obstructive hypertrophic cardiomyopathy who undergo myectomy exceeds that of patients who do not receive surgical treatment and, in addition, myectomy may be associated with reduced long-term risk of sudden cardiac death. These results should serve as a basis for comparison with newer nonsurgical treatment regimens.


Transaortic septal myectomy is currently considered to be the most appropriate treatment for patients with obstructive hypertrophic cardiomyopathy (HCM) who have severe symptoms unresponsive to medical therapy.[1-18] The learning curve for performing this procedure is considerable, however, and early surgical experience was associated with complications of complete heart block, ventricular septal defect, injury to the aortic or mitral valves, and incomplete relief of obstruction. In the few centers with a special interest in the management of HCM, the results of surgery have vastly improved. Drawing on the experience gained at our center, the Mayo Clinic, Rochester, MN, we present a review of septal myectomy in appropriate patients with obstructive HCM.

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