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Surgical management of hypertrophic obstructive cardiomyopathy



Septal myectomy is the most effective treatment modality for hypertrophic obstructive cardiomyopathy. A retrospective study was conducted to evaluate outcomes of surgical myectomy alone or with concomitant mitral valve procedures.


From December 2011 through December 2016, a total of 41 patients with symptomatic hypertrophic obstructive cardiomyopathy were operated. There were 14 females and 27 males, aged between 18 and 73 years (mean 49.8 years). All patients had drug refractory symptoms (dyspnea, palpitation, chest pain, fainting, limitation of daily physical activities). Twenty-one patients received septal myectomy alone, 10 patients had SM with mitral valve repair and 10 patients had SM with mitral valve replacement. The average follow-up was 38.45 ± 12.18 months.


Surgery led to symptomatic improvement in all patients. None of the patients were left with NYHA Class III and IV symptoms after surgery. The improvement in left ventricular outflow tract gradient was from 116.65 mmHg preoperatively to 22.47 mmHg. Mean septal thickness decreased from 2.35 to 1.74 cm. Post procedure permanent pacemaker implantation was required for one patient due to complete heart block, and 2 intracardiac devices were implanted due to resistant arrthymia. None of the patients required a repeat procedure during follow-up period. Operative mortality was 2.4%.


Septal myectomy is safe and effective. Concomitant mitral operations do not increase morbidity and mortality.

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  1. 1.

    Nishimura RA, Seggewiss H, Shaff HV. Hypertrophic obstructive cardiomyopathy surgical myectomy and septal ablation. Circ Res. 2017;121:771–83.

  2. 2.

    Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation. 2006;114:2232–9.

  3. 3.

    Sherrid MV, Balaram S, Kim B, Axel L, Swistel DG. The mitral valve in obstructive hypertrophic cardiomyopathy: a text in context. J Am Coll Cardiol. 2016;67(15):1846–58.

  4. 4.

    Morrow AG, Brockenbrough EC. Surgical treatment of idiopathic hypertrophic subaortic stenosis: technic and hemodynamic results of subaortic ventriculotomy. Ann Surg. 1961;154:181–9.

  5. 5.

    Kirklin JW, Ellis FH Jr. Surgical relief of diffuse subvalvular aortic stenosis. Circulation. 1961;24:739–42.

  6. 6.

    Messmer BJ. Extended myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg. 1994;58:575–7.

  7. 7.

    Schaff HV, Said SM. Transaortic extended septal myectomy for hypertrophic cardiomyopathy. Oper Tech Thorac Cardiovasc Surg. 2012;17:238–50.

  8. 8.

    Force ET, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, et al. ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733–79.

  9. 9.

    Wei D, Thibault DP, Rankin JS, Alkhouli M, Roberts HG, Vemulapalli S, Yerokun B, Ad N, Shaff HV, Smedira NG, Takayama H, McCarty PM, Thourani VH, Ailawadi G, Jacobs JP, Badhwar V. Contemporary surgical management of hypertrophic cardiomyopathy in the United States. Ann Thorac Surg. 2019;107:460–6.

  10. 10.

    Maron BJ, Yacoub M, Dearani JA. Benefits of surgery in obstructive hypertrophic cardiomyopathy: bring septal myectomy back for European patients. Eur Heart J. 2011;32:1055–8.

  11. 11.

    Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. J Am Coll Cardiol. 2011;58(25):e212–60.

  12. 12.

    Maron BJ, Dearani JA, Ommen SA, Maron MS, Schaff HV, Nishimura RA, et al. Low operative mortality achieved with surgical septal myectomy: role of dedicated hypertrophic cardiomyopathy centers in the management of dynamic subaortic obstruction. J Am Coll Cardiol. 2015;66:1307–8.

  13. 13.

    Mataracı I, Polat A, Songur MÇ, Aydın C, Yanartaş M, Erentuğ V, Kırali K, Yakut C. Hipertrofik obstrüktif kardiyomiyopatide cerrahi tedavi ve sonuçları. Turk J Thorac Cardiovasc Surg. 2009;17(4):243–8.

  14. 14.

    Wan CKN, Dearani JA, Sundt TM III, Ommen SR, Schaff HV. What isthe best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann Thorac Surg. 2009;88:727–32.

  15. 15.

    Desai MY, Bhonsale A, Smedira NG, Naji P, Thamilarasan M, Lytle BW, et al. Predictors of long termoutcomes in symptomatic hypertrophic cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction. Circulation. 2013;128:209–16.

  16. 16.

    Hong J, Shaff HV, Nishimura RA, Abel MD, Dearani JA, Li Z, et al. Mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy: implications for concomitant valve procedures. J Am Coll Cardiol. 2016;68:1497–504.

  17. 17.

    Bogachev-Prokophiev A, Afanasyev A, Zheleznev S, Fomenko M, Sharifulin R, Kretov E, et al. Mitral valve repair or replacement in hypertrophic obstructive cardiomyopathy: aprospective randomized study. Interact CardioVasc Thorac Surg. 2017;25:356–62.

  18. 18.

    Afanasyev A, Bogachev-Prokophiev A, Lenko E, Sharifulin R, Ovcharov M, Kozmin D, et al. Myectomy with mitral valve repair versus replacement in adult patients with hypertrophic obstructive cardiomyopathy: a systematic review and meta-analysis. Interact CardioVasc Thorac Surg. 2019;28:465–72.

  19. 19.

    Lee KS, Steward WJ, Lever HM, Underwood PL, Cosgrove DM. Mechanism of outflow tract obstruction causing failed mitarl valve repair. Anterior displacement of leaflet coaptation. Circulation. 1993;88:1124–9.

  20. 20.

    Brown ML, Abel MD, Click R, Morford RG, Dearani JA, Sundt TM, et al. Systolic anterior motion after mitral valve repair: is surgical interventation necessary? J Thorac Cardiovasc Surg. 2007;133:136–43.

  21. 21.

    Kaple RK, Murphy RT, DiPaola LM, Haughtaling PL, Lever HM, Lytle BW, et al. Mitral valve abnormalities hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes. Ann Thorac Surg. 2008;85:1527–36.

  22. 22.

    Hong J, Shaff HV, Ommen SR, Abel MD, Dearani JA, Nishimura RA. Mitral stenosis and hypertrophic obstructive cardiomyopathy: an unusual combination. J Thorac Cardiovasc Surg. 2016;151:1044–8.

  23. 23.

    Collis R, Tsang V, Pantazis A, Tome-Estaban M, Elliot PM, Mc Gregor CGA. Individualized surgical strategies for left venticular outflow tract obstruction in hypertrophic cardiomyopathy. Eur J Cardiothorac Surg. 2018;53:1237–43.

  24. 24.

    Shimahara Y, Fujita T, Kobayashi J, Fukushima S, Kume Y, Yamashita K, et al. Combined mechanicalmitral valve replacement and transmitral myectomy for hypertrophic obstructive cardiomyopathy treatment: an experience of over 20 years. J Cardiol. 2019;73:318–25.

  25. 25.

    Cui B, Wang S, Xu J, Wang W, Song Y, Sun H, et al. The Surgical Management of hypertrophic obstructive cardiomyopathy with the concomitant mitral valve abnormalities. Interact CardioVasc Thorac Surg. 2015;21:722–6.

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Correspondence to Arzu Antal.

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Antal, A., Boyacıoğlu, K., Akbulut, M. et al. Surgical management of hypertrophic obstructive cardiomyopathy. Gen Thorac Cardiovasc Surg (2020).

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  • Septal myectomy
  • Hypertrophic obstructive cardiomyopathy