In the American Heart Association Guidelines, transaortic septal myectomy is considered the preferred treatment for patients with obstructive hypertrophic cardiomyopathy (HCM) and heart failure symptoms unresponsive to medications. However, the inadequate number of surgeons and centers with large experience with myectomy in the USA and Europe limits patient access to surgery.
Aim and Methods:
To report the results of our myectomy program recently developed at the Hypertrophic Cardiomyopathy Center of the Policlinico di Monza, Italy. From July 2013 to March 2018, 316 consecutive patients with obstructive HCM underwent transaortic myectomy, mitral valve plasty and papillary muscles mobilization. Age ranged from 15 to 85 years, mean 54 ± 15. Preoperatively, 60 (19%) patients were in NYHA class II and 256 (81%) in class III-IV, all had LV outflow gradients ≥ 50 mmHg at rest or with physiologic provocation, and 90 (28%) had important mitral valve regurgitation.
Two patients died during hospitalization (0.6%). In the surviving patients, follow-up ranged from 1 to 51 months, mean 9 ± 11 months. At most recent evaluation, 6 (1.8%) patients had persistent severe symptoms (class III-IV), 8 (2.5%) had residual significant (≥ 30 mmHg) outflow gradient at rest, and 9 (2.8%) had moderate-to severe or severe mitral regurgitation.
Our recently developed septal myectomy program was based on the experience with this procedure acquired by the senior surgeon at a different institution and the development of a multi-specialistic team collaborating in the program. Our positive results provide a precedent for future efforts to expand the access to surgical myectomy for patients with obstructive HCM.