Hypertrophic Cardiomyopathy (HCM) is a genetic heart condition where the heart muscle thickens abnormally, making it harder for the heart to pump blood. It affects about 1 in 500 people and is a leading cause of sudden cardiac arrest in young athletes. Symptoms can range from mild (shortness of breath, fatigue) to severe (chest pain, fainting spells). While some patients manage HCM with medications, others may require surgical interventions like a myectomy to relieve obstruction and improve quality of life.
HCM is often misunderstood because many patients live without symptoms for years. However, when the thickened heart muscle blocks blood flow (a condition called left ventricular outflow tract obstruction), it can lead to life-threatening complications. Early diagnosis through echocardiograms or genetic testing is crucial. If you or a loved one has been diagnosed with HCM, understanding treatment options like myectomy can empower you to make informed decisions about care.
A myectomy (also called septal myectomy) is a surgical procedure to remove a portion of the thickened heart muscle (septum) that’s obstructing blood flow in patients with HCM. Unlike a heart transplant, this surgery preserves the patient’s own heart while restoring near-normal function. It’s considered the gold-standard treatment for drug-resistant HCM with severe symptoms.
The primary goal of a myectomy is to:
First performed in the 1960s, modern myectomies are highly refined and typically done by specialized cardiac surgeons. The procedure is not a cure for HCM (since the genetic cause remains), but it effectively addresses the most dangerous complications. Patients often report dramatic improvements—like being able to climb stairs or exercise without exhaustion—within weeks after recovery.
Not every HCM patient requires a myectomy. The surgery is typically recommended for those with:
Candidates undergo thorough evaluations, including stress tests and cardiac MRI, to confirm that myectomy is the best option. Importantly, surgery may be advised even for asymptomatic patients if tests reveal extreme obstruction or high-risk features. Pediatric cases are also considered, though the decision is more nuanced.
Common red flags that may prompt a myectomy referral include inability to perform daily activities, recurrent hospitalizations, or arrhythmias unresponsive to drugs. If you’re struggling with HCM symptoms despite medication, ask your cardiologist about a surgical consultation.
A myectomy is performed under general anesthesia and takes 3–4 hours. Here’s what to expect:
Most patients spend 1–2 days in the ICU followed by 5–7 days in the hospital. Advances like minimally invasive techniques (partial sternotomy) are reducing recovery times for select patients. Though the surgery is complex, success rates exceed 90% in experienced centers like the Mayo Clinic or Cleveland Clinic.
While myectomy is generally safe, all surgeries carry risks. Potential complications include:
The risk of mortality is <1% at high-volume centers but may be higher for older patients or those with additional health issues. Choosing a surgeon with extensive myectomy experience is critical—studies show complication rates drop significantly when the surgeon performs ≥20 procedures/year.
Post-surgery, patients are monitored for signs of complications like excessive swelling, fever, or irregular heartbeats. Early detection and intervention can mitigate most risks. Discuss your personal risk profile with your care team before deciding on surgery.
Recovery after myectomy is a gradual process:
Key tips for recovery:
Many patients report feeling better than they have in years by 3 months post-op. However, HCM still requires lifelong monitoring, even after successful surgery.
Myectomy boasts impressive outcomes:
Long-term, most patients still require medications (e.g., beta-blockers) to manage residual HCM effects, but doses are often lower. Annual follow-ups with echocardiograms are essential to monitor for late complications like mitral regurgitation or recurrent thickening.
For young patients, myectomy can be life-changing—allowing participation in sports, pregnancy, or other activities previously deemed unsafe. Research confirms that timely surgery reduces the risk of HCM-related sudden death to <1% per year.
Myectomy isn’t the only option for HCM. Alternatives include:
Key differences:
| Option | Pros | Cons |
|---|---|---|
| Myectomy | Durable results, low reintervention rate | Open-heart surgery risks |
| Alcohol Ablation | No sternotomy, shorter recovery | Higher pacemaker need (15–20%) |
Your cardiologist will recommend the best approach based on your anatomy, age, and overall health.
1. How long does a myectomy surgery take?
The procedure typically lasts 3–4 hours, though prep and recovery time add several more hours to your hospital stay.
2. Will I need a pacemaker after myectomy?
About 5–10% of patients require a pacemaker due to heart block caused by the surgery. This is more common in older patients or those with pre-existing conduction issues.
3. Can HCM come back after myectomy?
The removed muscle doesn’t regrow, but other areas of the heart may thicken over time. Lifelong monitoring is essential.
4. Is myectomy better than alcohol septal ablation?
For young, healthy patients, myectomy is preferred due to its durability. Ablation may suit older patients or those who can’t undergo surgery.