Septal Myectomy for Hypertrophic Cardiomyopathy

Overview

Septal myectomy is a surgical treatment used to treat patients with hypertrophic cardiomyopathy (HCM). The goal of septal myectomy is to reduce the heart muscle thickening that occurs in HCM patients. 

This procedure is an option for HCM patients who have not found symptom relief from medications or if an obstruction restricts blood ejection from the heart.

During the procedure, your physician will remove a small portion of the thickened septal wall, which will widen the opening from the left ventricle to the aorta.
Many procedures will feel immediate symptom relief after the procedure.

Candidates for septal myectomy for hypertrophic cardiomyopathy

Approximately 70% of patients have an obstruction associated with HCM. Your doctor will determine if you have an obstruction and, if so, develop a treatment plan customized for your case.

Some patients may be effectively treated with beta-blockers or calcium channel blockers, while more severe obstructions may need a septal myectomy.

Patients with advanced medical conditions or elderly patients are not ideal candidates for septal myectomy. These patients can often more effectively be treated with alternative therapy such as percutaneous alcohol septal reduction.

Preparing for a septal myectomy for hypertrophic cardiomyopathy

In preparation for a septal myectomy, your care team will outline what you can expect before, during, and after a septal myectomy. 

Your doctor may order any of the following tests:

• Blood tests.
• Cardiac catheterization.
• X-rays.
• Echocardiogram (ECHO).
• Electrocardiogram (EKG/ECG).

Your doctor will give you a list of instructions to follow, such as:

• What to eat before the procedure? Generally, you can eat a normal meal the night before the procedure, however, stop eating and drinking after midnight and take any required medication only with a sip of water.
• Inform your doctor of all medications you are taking, such as herbal medications and dietary supplements. Your care team will let you know if you can take your medicines as scheduled or if you need to alter your schedule.
• Wear comfortable clothing when you come to the hospital.

Expectations during a septal myectomy for hypertrophic cardiomyopathy

Septal myectomy is an open-heart surgery performed in an operating room. While a septal myectomy procedure takes three to six hours, preparation and recovery take several more hours.

A septal myectomy is performed under general anesthesia so that you will be asleep during the procedure. You also may need a ventilator to help you breathe during surgery. 

Your doctor will make an incision in your breastbone to gain access to your heart. You will be placed on a heart-lung machine, which will take over for the heart and lungs during the surgery. Once the heart-lung machine is functioning correctly and the heart is stopped, your surgeon will remove the excess septal wall tissue with special surgical tools. 

Once this process is complete, your doctor will divert the blood back into your heart and restart the heart with electrical shock if it is not starting on its own. 

If needed, your doctor may insert a pacemaker during the initial recovery period. The pacemaker will ensure your heart is pacing correctly. 

Once the procedure is complete, your doctor will sew the sternum together with sutures or surgical staples.

Recovering from a septal myectomy for hypertrophic cardiomyopathy

After the procedure, you will be moved into a cardiac intensive care unit for five to seven days. When you wake up for anesthesia, your breathing tube will be removed, and you can start consuming liquids and gradually solids the day after surgery.

Any devices used to help your body function during recovery, such as urine catheters, pacemakers, or drainage tubes, will slowly be removed.

You will gradually begin breathing exercises and physical therapy. Cardiac rehabilitation is also recommended after your discharge from the hospital.

It could take as long as six to six to eight weeks to fully recover after septal myectomy surgery. Most patients can drive within three to eight weeks after surgery.

Your doctor will give you specific recovery details and recommendations on when you can return to your daily routine or work.

When to seek care

If you think you may need a septal myectomy for hypertrophic cardiomyopathy, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a cardiologist for more specialized treatment.