Medicine:Septal myectomy

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Septal myectomy
SpecialtyCardiology

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]

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]

References

  1. ↑ Cui, Hao; Schaff, Hartzell V. (2020). "80. Hypertrophic cardiomyopathy". in Raja, Shahzad G. (in en). Cardiac Surgery: A Complete Guide. Switzerland: Springer. pp. 735–748. ISBN 978-3-030-24176-6. https://books.google.com/books?id=kcPPDwAAQBAJ&pg=PA735. 
  2. ↑ Ralph-Edwards, Anthony; Vanderlaan, Rachel D.; Bajona, Pietro (July 2017). "Transaortic septal myectomy: techniques and pitfalls". Annals of Cardiothoracic Surgery 6 (4): 410–415. doi:10.21037/acs.2017.07.08. ISSN 2225-319X. PMID 28944183. 
  3. ↑ "History of Changes for Study: NCT04603521" (in en). https://clinicaltrials.gov/ct2/history/NCT04603521?V_25=View. 
  4. ↑ "Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy". J Am Coll Cardiol 46 (3): 470–6. 2005. doi:10.1016/j.jacc.2005.02.090. PMID 16053960. 
  5. ↑ "Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score". J Thorac Cardiovasc Surg 129 (2): 351–8. 2005. doi:10.1016/j.jtcvs.2004.08.047. PMID 15678046. 
  6. ↑ "Myectomy or alcohol septal ablation surgery and percutaneous intervention go another round". J. Am. Coll. Cardiol. 49 (3): 358–60. 2007. doi:10.1016/j.jacc.2006.10.029. PMID 17239718. 



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