Septal myectomy for obstructive hypertrophic cardiomyopathy: the gold standard

Septal myectomy effectively and definitively relieves LVOT obstruction and cardiac symptoms in adults and children with obstructive hypertrophic cardiomyopathy (HCM). Abnormalities of the mitral valve can be addressed without the need for mitral valve replacement in almost all circumstances. Concomitant mitral valve repair for myxomatous disease requires minor modifications when performed in conjunction with septal myectomy; mitral valve replacement is rarely necessary. In experienced centers, early mortality for isolated septal myectomy is low (approximately 1%) and overall results are excellent and continue to improve in the current era. Symptomatic improvement with myectomy is expected for most; 90% of patients improve by at least one functional class, and most remain improved on late follow-up. Late survivorship is improved compared to nonoperated patients with obstructive HCM, and myectomy may be associated with reduced risk of sudden cardiac death. These results should serve as the gold standard and a basis for comparison with newer nonsurgical modalities, i. e., septal alcohol ablation.