Septal myectomy in context: Clinical acumen and procedural expertise

Abstract

Surgical septal myectomy for the relief of symptomatic outflow tract obstruction in hypertrophic cardiomyopathy (HCM) has been of continual interest since its initial introduction nearly 60 years ago. Despite early concerns about overall safety, repeated investigations have shown myectomy to be safe, efficacious, and durable when performed by experienced surgeons in experienced centers. 1,2 There are also data that suggest that myectomy may ‘‘normalize’’ survival. 3 This compelling experience has positioned myectomy to be the preferred treatment for most patients with drug-refractory symptoms attributed to dynamic left ventricular outflow tract obstruction. 4 In this issue of the Journal, Desai and colleagues 5 provide an update on the Cleveland Clinic experience with myectomy in 990 patients and compared these patients with 540 other patients HCM who were seen at their center and not offered myectomy. They report better long-term survival in the patients who underwent myectomy than among the patients who did not undergo operation.