Myectomy: Still the Gold Standard for HOCM

An expert panel comprised of many of the world’s top HCM experts recently published a retrospective analysis in The American Journal of Cardiology which looked at septal myectomy over the last 60 years of practice.

 Beginning with the introduction of the procedure at the National Institute of Health in the early 1960s, this paper surveys the history of the procedure until the present day.  The conclusion of the paper is that myectomy remains the best treatment for patients with obstructive hypertrophic cardiomyopathy.

Those patients eligible for septal myectomy have a left ventricular outflow gradient of at least 50 mmHg with progressive heart failure symptoms that don’t respond to existing drugs. The surgery relieves the obstruction in the heart and normalizes left ventricular pressures by enlarging the outflow tract and improving or eliminating the systolic anterior motion of the mitral valve.

The paper described the procedure in depth while pointing out that:

  • Mortality for the procedure at high volume centers is .6%, making it one of the safest open heart surgeries there is.
  • Symptoms are relieved in 90% of patients by at least one NYHA functional class, with 75% of patients being restored to NYHA Class I.
  • A long term survival benefit is conferred on patients who undergo myectomy. 

HCMBeat has written in the past about the best timing for myectomy, as well as the fact that older people can benefit from the surgery.

Following his own myectomy, Ron Petrovich, who works in Public Affairs at Mayo Clinic, shared his tips for recovery a few years back, while nurse Jill Celeste has written about her need for a second myectomy after a first incomplete surgery done at a low volume center.

On a personal note, it has been 16 years since my own myectomy and I am doing great!  I am so grateful that I had the opportunity to travel to Mayo Clinic to undergo this life changing surgery.  You can read a bit more about my post-surgical life as well the surgery itself on the blog about the surgery and what I had to say last year on the 15th anniversary of my myectomy.

Finally, this blog has a list of resources for patients who plan to undergo myectomy.

When evaluating treatments for obstruction, it is important to be sure that you understand all of your options. Together with guidance from your medical team this will allow you to make the best decision for you.

 

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