Septal myectomy is a

cardiac surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to co ...

treatment for hypertrophic cardiomyopathy (HCM). 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 The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes o ...

. 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. Septal myectomy was established by Andrew G. Morrow in the 1960s. __TOC__

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:

Comparison with alcohol ablation

Either alcohol ablation or myectomy offers substantial clinical improvement for patients with

hypertrophic obstructive cardiomyopathy Hypertrophic cardiomyopathy (HCM, or HOCM when obstructive) is a condition in which the heart becomes thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This r ...

. One non-randomized comparison suggested that hemodynamic resolution of the obstruction and its sequelae are more complete with myectomy. Whether one or the other treatment is preferable for certain patient types is debated among cardiovascular scientists.

References

{{cardiac surgery Cardiac surgery Cardiomyopathy