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. 2025 Aug 29:ehaf560.
doi: 10.1093/eurheartj/ehaf560. Online ahead of print.

Surgical myectomy for hypertrophic cardiomyopathy: procedural volume and outcomes

Tijn J P Heeringa  1   2 , Romy M J J Hegeman  3   4 , Yvonne Koop  2   5 , Sulayman El Mathari  4   6 , Marieke Hoogewerf  7 , Maaike M Roefs  8 , Karin C Smits  9   10 , Dorien Laenens  11 , Giulia De Zan  7 , Maarten J Cramer  7 , Marco Guglielmo  7 , Pim van der Harst  7 , Ilonca Vaartjes  2 , Mostafa M Mokhles  1 , Patrick Klein  3   4 , Niels P van der Kaaij  1   6
Affiliations

Surgical myectomy for hypertrophic cardiomyopathy: procedural volume and outcomes

Tijn J P Heeringa et al. Eur Heart J. .

Abstract

Background and aims: Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates.

Methods: All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate.

Results: Isolated surgical myectomy was performed in 22%, surgical myectomy with one concomitant procedure in 54%, and surgical myectomy with two or more concomitant procedures in 24%. Thirty-day complication rates concerned mortality (5%), ventricular septal defect (2%), stroke (3%), and surgical reoperation (2%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 ± 30 mmHg to 13 ± 12 mmHg postoperatively, systolic anterior motion from 80% to 8%, and mitral regurgitation grade 3 or 4 from 31% to 6%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and ≥2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95% confidence interval: 1.43-8.09); P = .007).

Conclusions: Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93% of patients in this multicentre cohort. Female sex, ≥ 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted.

Keywords: Echocardiography; Heart septum; Hypertrophic obstructive cardiomyopathy; Left ventricular outflow obstruction; Morrow; Surgical volume.

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