Septal Myectomy

Definition

Septal myectomy is open-heart surgery performed to reduce the thickening of the ventricular septum to eliminate obstruction to blood flow and restore heart pressures to normal, with the capability to reverse heart failure in HCM.

Procedure

During this procedure, an incision is made in the chest to access the heart and a heart-lung bypass machine takes over the work of the heart and lungs. The surgeon then makes a small incision in the lower aorta to see your ventricular septum through your aortic valve.

Then, through direct visualization by the surgeon, a small portion of the ventricular septum muscle is carefully extracted. This widens the outflow area, which therefore prevents the mitral valve from contacting the septum. The removal of this muscle is permanent. The muscle will not grow back. (In some patients, the mitral valve also needs to be repaired at this point for ‘leakiness,’ or its leaflet shortened, as these can also contribute to restriction of blood flow.)

The entire procedure usually takes 3-5 hours to complete.

What To Expect

By successfully eliminating the obstruction, pressures in the heart return to normal and limiting symptoms from HCM are dramatically improved or eliminated. Relief of obstruction is seen immediately. However, it can take several weeks to months to recover and feel the full benefits of the surgery.

If you have obstructive HCM and your symptoms have not been responsive to medical therapy, you may be a candidate for the invasive surgical procedure we have described above. Your candidacy will be determined after our HCM experts conduct a comprehensive cardiac evaluation. If the decision is made to undergo surgical myectomy, we will coordinate a pre-operative visit and surgical date with you after conferring with our surgical team.

High-benefit, low-risk myectomy surgery is an important element in the care for symptomatic obstructive HCM patients and is offered at Lahey with Dr. Prem Shekar as the senior operating surgeon, and Chairman of Cardiac and Thoracic Surgery at Lahey. Such expert surgery will reliably reverse heart failure symptoms in patients with obstruction and return the vast majority of patients to an excellent quality of life.

Results

Postoperative, prognosis is excellent for the vast majority of myectomy patients. About 95% of patients report 90-100% improvement in symptoms, including a substantial increase in exercise tolerance and the ability to enjoy many physical activities without experiencing shortness of breath, chest pressure, chest pounding, lightheadedness or fatigue.

Remember: Surgery does not eliminate your HCM. However, it is expected to significantly improve your quality of life once obstruction of blood flow is permanently eliminated.

Septal Myectomy Surgery for Hypertrophic Cardiomyopathy

Watch our overview of the septal myectomy surgical procedure.