Septal myectomy is currently considered the safest and most durable way to reduce obstruction caused by HCM and to address severe symptoms. The procedure involves cutting away the thickened heart muscle to restore blood flow to the hypertrophic heart.
With our increased knowledge of the anatomy of the hypertrophic heart and with advanced imaging techniques, we are now able to cut deeper and remove even more of the fibrous tissue that obstructs blood flow, achieving better results.
During this operation, the surgeon excises a portion of the thickened septal wall to widen the outflow channel from the left ventricle to the aorta. Many patients experience significant relief immediately after surgery.
Myectomy is indicated for patients with significant obstruction.
After making a chest incision, the surgeon inserts a cannula into the aorta in the right atrium of the heart. He then uses needles to measure the pressure gradients (the difference in pressure between the left ventricle and the aorta).
At this time, the surgeon may administer a drug to increase pressure gradients. The needles are then removed and the anatomy of the heart is further evaluated by an echocardiogram in the operating room. The patient is then placed on a bypass machine and the heart is temporarily stopped.
The surgeon inspects the left ventricle tract and mitral valve then identifies the hypertrophic muscle underneath the aortic valve by its whitish color.
The hypertrophic muscle is then removed, with great care and precision, to avoid any injury to the heart's conduction system. The surgeon proceeds to cuts away more fibrous tissue, as necessary, moving deeper, toward apex of the ventricle.
The chest is closed, the patient is taken off the bypass machine and surgeon again measures the pressure gradients to check the function of both the left ventricle and aorta.
Dr. Hiroo Takayama – Which hypertrophic cardiomyopathy patients are good candidates for surgery?
Surgeries for related conditions and end-stage HCM
HCM patients may also suffer from valve disease or coronary artery disease and may require surgery to correct these problems as well. Our cardiac surgeons have created innovative techniques for valve repair and our center is world-renowned for providing patients with the best outcomes and post-operative quality of life.
NewYork-Presbyterian has the largest heart failure program in the US, and our surgeons are best equipped to manage those patients who progress to end-stage HCM, requiring left ventricular support and/or heart transplantation.