Septal myectomy for hypertrophic cardiomyopathy: important surgical knowledge and technical tips in the era of increasing alcohol septal ablation
- 453 Downloads
Hypertrophic cardiomyopathy (HCM) is the most commonly inherited cardiac disease—recent studies suggest a prevalence as high as 1 in 200. For symptomatic patients with obstructive HCM who are refractory to medical therapy, septal reduction is indicated. Septal myectomy (SM) is considered the gold standard septal reduction technique. However, due to a shortage of surgeons who are experienced in this technique, alcohol septal ablation (ASA) has overtaken SM as the most commonly performed procedure for obstructive HCM. In this review, we summarize the existing literature comparing SM with ASA and describe recent innovations in operative technique, including a detailed description of the approach used at our institution.
KeywordsHypertrophic cardiomyopathy Septal myectomy Alcohol septal ablation
Compliance with ethical standards
Conflict of interest
Dr. Chiang has no conflicts of interest to disclose. Dr. Shimada has no conflicts of interest to disclose. Dr Ginns has no conflicts of interest to disclose. Dr Weiner has no conflicts of interest to disclose. Dr Takayama has no conflicts of interest to disclose.
Supplementary material 1 (M4V 107315 KB)
- 2.Maron BJ, Dearani JA, Ommen SR, 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(11):1307–8.CrossRefPubMedGoogle Scholar
- 5.Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;58(25):2703–38.CrossRefPubMedGoogle Scholar
- 22.Desai MY, Bhonsale A, Smedira NG, Naji P, Thamilarasan M, Lytle BW, et al. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction. Circulation. 2013;128(3):209–16.CrossRefPubMedGoogle Scholar
- 28.Kim LK, Swaminathan RV, Looser P, Minutello RM, Wong SC, Bergman G, et al. Hospital volume outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: US Nationwide Inpatient Database, 2003–2011. JAMA Cardiol. 2016;1(3):324–32.CrossRefPubMedGoogle Scholar