Septal myectomy

Septal myectomy, the surgical removal of a section of heart muscle, is considered by experts to be the most effective and low-risk treatment for symptoms of hypertrophic obstructive cardiomyopathy (HOCM), in which the heart muscle thickens enough to obstruct the flow of blood. The surgery has been performed for almost 50 years and can dramatically improve symptoms in over 90 percent of patients. The vast majority return to a normal lifestyle with no recurrence of symptoms.

Health Tips from Dr. Healy: Video: What men need to know about their cholesterol Choose another disease or condition... Allergic Rhinitis Allergies, Food Allergy & Asthma Center Alzheimer's Disease Anxiety Aortic Aneurysms Arrhythmia Arthritis, Osteo- (OA) Arthritis, Rheumatoid (RA) Asthma Atopic Dermatitis Attention Deficit Hyperactivity Disorder (ADHD) Back Pain Brain Tumor Bones, Joints & Muscles Center Breast Cancer Brain & Behavior Center Brain Tumor Cancer Center    Brain Tumor    Breast Cancer    Cancer Prevention    Clinical Trials    Colorectal Cancer    Endometrial Cancer    Living With and Beyond Cancer    Lung Cancer    Prostate Cancer    Skin Cancer Cardiomyopathy Cataracts Cholesterol Control Clinical Trials Chronic Obstructive Pulmonary Disease (COPD) Colorectal Cancer Congenital Heart Disease Congestive Heart Failure (CHF) Coronary Artery Disease (CAD) Crohn's Disease Depression Diabetes Center Diabetes, Type 1 Diabetes, Type 2 Digestive Disorders Center Eczema Endometrial Cancer Erectile Dysfunction (ED) Eye & Vision Center Fibromyalgia Food Allergies Gallstone Disease Gastroesophageal Reflux Disease (GERD) GERD Glaucoma Hay Fever Headache Heart Center Hepatitis A Hepatitis B Hepatitis C High Blood Pressure Hypertension Hypertrophic Cardiomyopathy (HCM) Impotence Insomnia Irritable Bowel Syndrome (IBS) Living With and Beyond Cancer Losing Weight Lung Cancer Macular Degeneration Memory Loss Osteoarthritis (OA) Osteoporosis Parkinson's Disease Peptic Ulcer Prediabetes Prostate Cancer Respiratory Disorders Center Restless Legs Syndrome (RLS) Rheumatoid Arthritis (RA) Sexual & Reproductive Health Center Sinusitis Skin Cancer Sleep Apnea Sleep Center Stroke Type 1 Diabetes Type 2 Diabetes Ulcerative Colitis (UC) Weight Control What is your heart risk? Use our calculator to find out. America's Best Hospitals for Heart and Heart Surgery HCM-Related Clinical Trials Information Email this page Print this section

New research indicates that for individuals with HOCM who are symptomatic, myectomy may actually normalize their life expectancy. For patients who have a myectomy, the survival rate at one year is 99 percent; at five years, 98 percent; and at 10 years, 95 percent. By comparison, for patients with obstruction who do not have a myectomy, survival at one year is 94 percent; at five years, 89 percent; and at 10 years, 73 percent.

As is true for other types of open-heart surgery, myectomy requires general anesthesia and cardiopulmonary bypass, a machine that takes over the functions of the heart and lungs. The procedure lasts three to four hours, including 30 to 45 minutes on cardiopulmonary bypass. The surgeon begins by making an incision in the center of the chest to access the heart. After cardiopulmonary bypass has begun, the surgeon makes an incision in the aorta, entering the heart through the aortic valve to cut away a portion of the overgrown muscle. This physically increases the space inside the left ventricle, removes the obstruction in the heart and eliminates any regurgitation of blood through the mitral valve as shown in Figure 5. This procedure usually requires five to six days in the hospital with the patient back to work in as soon as six weeks.

The risks from open-heart surgery depend on the patient's general health and age. In a younger, otherwise healthy person, the risk of dying during or shortly after a myectomy performed at a hospital with a lot of experience in the procedure is less then 1 percent; at other hospitals, it can be as high as 5 percent. Less than 3 percent of patients experience a complete heart block, where heart muscle becomes unable to transmit electrical signals, requiring a permanent pacemaker. In less than 1 percent of patients, the procedure punctures the septum between the left and right ventricles

The success of a myectomy depends on the technical expertise and experience of the surgical team as well as the type of hypertrophy. Patients have the best outcomes if their surgery is performed at experienced medical centers where the procedure is performed by specialized teams, and the thickening of the heart muscle occurs primarily in the lower part of the septum that separates the left and right ventricles. For individuals with concentric HCM, or thickening of the muscle throughout the heart, myectomy may help alleviate the symptoms of HOCM, but may not entirely eliminate them.

Regrowth of the removed muscle after myectomy has not been reported in adults. For children, however, the muscle may grow back, requiring continued medication throughout their lives.