Hypertrophic Cardiomyopathy Surgical Treatment
The Hypertrophic Cardiomyopathy (HCM) Program at University of Utah Health is one of the nation’s few programs for comprehensive HCM evaluation and management. Our multidisciplinary team works together to ensure the best heart care for our patients.
Our providers specialize in treating HCM with an open-heart procedure called septal myectomy. During the procedure, one of our cardiothoracic surgeons will remove a portion of the septum (the section of muscle that separates the two lower chambers of your heart) to allow more blood to enter and leave the heart, helping the heart work more efficiently.
Most patients see a significant reduction in HCM symptoms after a septal myectomy.
Best Candidates for Septal Myectomy
Approximately 70 percent of patients with HCM will develop hypertrophic obstructive cardiomyopathy (HOCM). This condition occurs when the thickened septum blocks blood flow through the heart. The heart muscle must work harder to move blood into and out of the heart. As a result, you will experience:
- chest discomfort,
- shortness of breath, and
- dizziness or fainting.
The best candidates for septal myectomy are patients who have HOCM and have not responded to medications or other treatment. Patients with apical hypertrophic cardiomyopathy, a condition that causes thickening in the middle and tip of the left ventricle, are potential candidates for this procedure.
How to Prepare for Your Septal Myectomy
Most patients arrive at U of U Health on the day of their septal myectomy surgery. Your surgeon will provide you with the following instructions.
- Stop eating or drinking for 12 hours before surgery.
- Stop using tobacco products as soon as possible. Smoking slows down the recovery process.
- Continue taking your medications as directed by your surgeon.
Find a Hypertrophic Cardiomyopathy Specialist
Septal Myectomy Technique
A septal myectomy is an open-heart procedure performed under general anesthesia. After you are asleep, a cardiothoracic surgeon will make a 6- to 8-inch-long incision (cut) on the center of your chest. They will access the main cavity of your heart and remove the thickened heart muscle.
While your surgeon is cutting away the thickened heart muscle, you will be connected to a heart-lung machine. It will perform your heart’s functions and keep your blood oxygenated throughout the surgery. This will help prevent any damage to your organs or bodily tissues during the procedure. Once the septal myectomy is complete, your heart will begin beating on its own again.
The entire procedure will take up to four hours to complete.
You may wake up with a breathing tube in your throat. Your recovery team will remove the tube once you are awake and can breathe on your own. You will also have an IV in your arm and neck so your caregivers can give you medications.
You should expect to spend five to seven days in the hospital after surgery. You will remain in the cardiovascular intensive care unit, where your recovery team will closely monitor your vital signs and administer medications. After one or two days, our team will transfer you to a private hospital room until you are ready to go home.
During your stay, you will receive physical and occupational therapy. We will refer you to an outpatient cardiac rehabilitation program after you leave the hospital.
Septal Myectomy Recovery
Prior to discharge, our rehabilitation, nursing, and physician/surgeon teams will provide you with a folder that addresses a variety of concerns and information related to your surgery and your recovery at home. After your surgery, you will experience some soreness, particularly in your arms. Your surgeon will tell you which pain-relieving medications you can take. If your job requires physical labor, you will need to take time off for several weeks.
Monitor your weight and temperature daily. If you lose weight or run a temperature of more than 100.4°F, contact your care team immediately.
A bandage will keep your incision (cut) clean and dry. Follow your surgeon’s instructions for wound care. Your surgeon will remove your stitches or staples about two weeks after surgery. You will have a scar on the center of your chest from the incision.
Return to Activity
Initially, you will feel tired but will regain your strength as you heal. You should avoid lifting anything heavier than 10 pounds for eight weeks after surgery or until your surgeon has cleared you to resume normal activities like driving, exercising, and working. Until then, you should do light activities and walk daily to help your body recover.
Septal Myectomy Complications
Septal myectomy is safe, however, as with any surgery, there are potential complications. Your age or the presence of other medical conditions like diabetes could increase your risk of complications.
Infection, bleeding, and stroke are the most significant risk factors of this surgery, but they are rare. Some patients may require a pacemaker to assist with coordinating their heartbeats since the heart's electrical system runs through the surgical site of a myectomy.
Septal Myectomy Survival Rates
Septal myectomy is a procedure that’s been performed successfully for decades. The survival rate for otherwise healthy patients is above 99 percent when performed in experienced centers such as U of U Health.
Does Septal Myectomy Cure Hypertrophic Cardiomyopathy?
Septal myectomy does not cure HCM. However, it will dramatically reduce symptoms of fatigue, lightheadedness, shortness of breath, and chest discomfort because the procedure makes more room for blood to flow through your heart.
Five to 10 percent of patients may experience a rethickening of the septal wall after surgery. But for most patients, their septum will not become enlarged again.
Make An Appointment With a Hypertrophic Cardiomyopathy Specialist
Hypertrophic cardiomyopathy (HCM) is a complex disease that requires the expertise of doctors from multiple specialties. If you have HCM, our specialists in our HCM Program will follow your condition and recommend the best treatment.
If you need septal myectomy surgery, your cardiologist will refer you to a cardiothoracic surgeon for an evaluation. Call 801-585-5122 or email HCM@hsc.utah.edu for more information or to request an appointment.