Septal myectomy
| Septal myectomy | |
|---|---|
| Specialty | Cardiology |
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]
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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
- ^ Cui, Hao; Schaff, Hartzell V. (2020). "80. Hypertrophic cardiomyopathy". In Raja, Shahzad G. (ed.). Cardiac Surgery: A Complete Guide. Switzerland: Springer. pp. 735–748. ISBN 978-3-030-24176-6.
- ^ 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. PMC 5602211. PMID 28944183.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ "History of Changes for Study: NCT04603521". clinicaltrials.gov. Retrieved 30 October 2022.
- ^ Ommen S, Maron B, Olivotto I, Maron M, Cecchi F, Betocchi S, Gersh B, Ackerman M, McCully R, Dearani J, Schaff H, Danielson G, Tajik A, Nishimura R (2005). "Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy". J Am Coll Cardiol. 46 (3): 470–6. doi:10.1016/j.jacc.2005.02.090. PMID 16053960.
- ^ Ralph-Edwards A, Woo A, McCrindle B, Shapero J, Schwartz L, Rakowski H, Wigle E, Williams W (2005). "Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score". J Thorac Cardiovasc Surg. 129 (2): 351–8. doi:10.1016/j.jtcvs.2004.08.047. PMID 15678046.
- ^ Heldman AW, Wu KC, Abraham TP, Cameron DE (2007). "Myectomy or alcohol septal ablation surgery and percutaneous intervention go another round". J. Am. Coll. Cardiol. 49 (3): 358–60. doi:10.1016/j.jacc.2006.10.029. PMID 17239718.
