Septal Myectomy: Surgical Treatment for Hypertrophic Cardiomyopathy

Who Is a Good Candidate for Septal Myectomy?

Septal myectomy is a complex open-heart surgery and, although it is a highly effective treatment for HCM, it isn’t appropriate for all patients. This procedure may be recommended if the patient:

• Has not improved with medications such as beta blockers, blood thinners and heart rhythm drugs
• Has severe thickening of the septum
• Is healthy enough to withstand open-heart surgery

Preparing for a Septal Myectomy

Before scheduling your procedure, your surgeon will advise you how to prepare in the days leading up to the operation. You may be told to stop taking certain medications, stop smoking and drinking alcohol, and make other lifestyle modifications for a brief time prior to surgery. For your safety, it is important to follow your doctor’s recommendations exactly.

Certain pre-operative tests may also be ordered to ensure you are healthy enough to undergo the surgery. These may include blood tests, chest X-rays and heart-specific exams such as electrocardiogram, cardiac MRI and echocardiogram.

The Procedure

A septal myectomy usually takes 3 – 4 hours and is performed in a hospital operating room with the patient under general anesthesia.

Once the patient is asleep, the surgeon will make a 6 – 8 inch incision down the middle of the chest and through the breastbone to expose the heart. The patient is then connected to a heart-lung machine (cardiopulmonary bypass) that will take over the functions of the heart and lungs to allow the surgery to be performed.

The surgical team works together, using specialized instruments to remove the thickened portion of the septum and perform any additional procedures that may be needed, such as mitral valve repair. The heart-lung machine is disconnected and, once the team confirms that the heart and lungs are functioning independently, the incision is closed with sutures.

Recovery after Septal Myectomy

Immediately after surgery, patients are monitored in the cardiothoracic intensive care unit (CTICU). As the patients recover, they are transferred to the cardiothoracic floor for the remainder of their time in the hospital. A urine catheter and/or chest drainage tube may be left in place for up to two days.

Physical therapy will begin while the patient is still in the hospital – most will be encouraged to get up and walk after 48 hours. Most patients will remain in the hospital for 5 – 7 days.

Outpatient cardiac rehab will likely be recommended after discharge to further enhance recovery. Most patients will regain their typical energy levels in 2 – 3 weeks.

Benefits & Risks of Septal Myectomy

Septal myectomy has a high success rate for treating hypertrophic cardiomyopathy. Patients who are deemed healthy enough to undergo this surgery will often experience significant improvement of symptoms such as chest pain (angina), lightheadedness, fainting, shortness of breath and fatigue.

Although septal myectomy is generally a low-risk procedure, like any major surgery, it can lead to complications, including:

• Infection
• Heart rhythm disruptions
• Bleeding or clotting problems
• Excess fluid buildup around the heart or lungs

These complications are more common in people with one or more risk factors, such as smoking, older age and the existence of other health problems. Patients are advised to talk to their cardiologist about the risks and benefits of septal myectomy before scheduling their surgery.

Local Access to World-Class Expertise

The cardiac surgeons at University Hospitals Harrington Heart & Vascular Institute have the advanced training and experience needed to perform a wide range of complex heart surgeries, including septal myectomy.

Our expert, multidisciplinary teams work together to provide patients with a safe, seamless surgical experience from preparation and pre-op testing, to day-of-surgery navigation and support, through rehabilitation and recovery.