Treatment Strategies for Hypertrophic Cardiomyopathy: Surgical
Hartzell V. Schaff, Fernando M. Juarez-Casso
Abstract
Septal myectomy is a well-established procedure in current practice, usually reserved for patients with symptomatic HCM who are unresponsive to medical therapy. The surgical approach is tailored to the patient's pathophysiology and septal morphology as determined by pre- and intraoperative imaging. An extended transaortic myectomy is the standard procedure for patients with isolated subaortic obstruction. Transapical myectomy is typically performed for patients with long or MVO, utilizing an apical ventriculotomy for better exposure to the midventricular septum. In some cases, transapical myectomy may be performed alone or in combination with transaortic myectomy for patients with complex subaortic obstruction. This approach can also help repair apical aneurysms common in patients with MVO. In patients with severe symptomatic diastolic heart failure because of extensive apical hypertrophy, a transapical myectomy to increase the LV cavity size and improve diastolic function is an effective treatment option. Overall, septal myectomy has been shown to provide superior outcomes compared with alternative treatments such as ASA or cardiac transplantation, offering patients with all types of HCM excellent symptom relief, functional improvement, low morbidity and mortality rates, and long-term survival.