Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (analysis Spanning 60 Years of Practice): AJC Expert Panel.

Surgical myectomy remains the time-honored primary treatment for hypertrophic cardio-myopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on > 50 years experience, surgery reliably reverses disabling heart failure by per-manently abolishing mechanical outflow impedance and mitral regurgitation, with nor-malization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increas-ing significantly in number over the most recent 15 years. Performed in experienced multi-disciplinary institutions, perioperative mortality for myectomy has declined to 0.6%, becoming one of the safest currently performed open-heart procedures. Extended myec-tomy relieves symptoms in > 90% of patients by & GE; 1 NYHA functional class, returning most to normal daily activity, and also with a long-term survival benefit; concomitant Cox-Maze procedure can reduce the number of atrial fibrillation episodes. Surgery, pref-erably performed in high volume clinical environments, continues to flourish as a guide-line-based and preferred high benefit: low treatment risk option for adults and children with drug refractory disabling symptoms from obstruction, despite prior challenges: higher operative mortality/skepticism in 1960s/1970s; dual-chamber pacing in 1990s, alco-hol ablation in 2000s, and now introduction of novel negative inotropic drugs potentially useful for symptom management. (c) 2022 The Authors. Published by Elsevier Inc.