Surgical Approaches to Hypertrophic Obstructive Cardiomyopathy

Abstract

Left ventricular outflow tract obstruction secondary to hypertrophic obstructive cardiomyopathy remains a challenging entity facing clinicians. Despite the success of invasive therapies, some clinicians remain hesitant because of early results with unacceptable morbidity and mortality rates. However, current literature strongly suggests improved short- and long-term outcomes with extended septal myectomy and alcohol septal ablation compared with patients not undergoing such interventions. This review evaluates hypertrophic obstructive cardiomyopathy treatment with a focus on short- and long-term outcomes, perioperative complications, and major tenets of surgical intervention. The data reveal mortality rates approaching zero, and perioperative complications occur infrequently. Alcohol septal ablation and extended septal myectomy both consistently decrease left ventricular outlet tract pressure gradients and result in improved functional capacity with lower New York Heart Association class and should be recommended as treatment for patients with symptoms refractory to standard medical treatment.

Keywords: alcohol septal ablation; extended septal myectomy; hypertrophic obstructive cardiomyopathy; mitral regurgitation; sudden cardiac death.