Surgical management of hypertrophic obstructive cardiomyopathy.

Abstract

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 73years (mean 49.8years). 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 ± 12.18months. 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 116.65mmHg preoperatively to 22.47mmHg. Mean septal thickness decreased from 2.35 to 1.74cm. 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.