Septal Myectomy Surgery for Hypertrophic Cardiomyopathy

Septal myectomy is surgery to thin out the wall between the left and right side of the heart, which becomes thick and obstructs blood flow in people with HCM. Thinning the septum also reduces mitral valve regurgitation, a condition in which blood flows backward into the atrium, or upper chamber of the heart. Septal myectomy is the most commonly performed surgical procedure for people with HCM.

In this procedure, the surgeon removes part of the muscle in the wall of the septum to widen the left ventricle outflow and limit force on the mitral valve. This procedure improves blood flow to the aorta, the body’s largest artery. Septal myectomy is also used to treat midventricular and apical HCM, which affect other specific parts of the septum.

Septal myectomy is open heart surgery and requires general anesthesia. Because the heart needs to remain still during the procedure, a heart–lung bypass machine is used to perform the work of these organs. Before surgery, your cardiac surgeon discusses the expected benefits and risks of the procedure.

During the procedure, your NYU Langone surgeon makes an incision in the chest and divides the breastbone. They then use surgical instruments to reach the thickened septum through the aortic valve, the gateway between the left ventricle and the aorta. The surgery takes four hours.

Many people who receive a septal myectomy procedure also need a procedure to repair the mitral valve, which can be stretched out by obstructions in the heart and the increased effort needed to pump blood through the body. Our surgeons typically repair the person’s own mitral valve rather than replace it with an artificial valve, which may need to be replaced later in life and requires the lifelong use of anticoagulant medications.

Mitral valve repair is often performed during a septal myectomy. The mitral valve is the gateway between the heart’s left upper chamber, which receives blood from the lungs, and the left lower chamber, which pumps blood to the body through the aorta. HCM can cause the leaflets of the mitral valve, which open and close to regulate blood flow, to become elongated. When this happens, repairing the valve can help remove obstructions that are affecting blood flow and reduce regurgitation, or blood flowing backwards through the heart.

Our surgeons pioneered procedures that are now commonly used to repair the mitral valve in people with HCM: horizontal plication and residual leaflet excision, or ReLex. Horizontal plication improves blood flow by shortening and stiffening the valve to prevent abnormal motion. ReLex removes residual or extra portions of the mitral valve that are affecting blood flow through the valve.

After surgery, you remain in the intensive care unit for 24 hours, so your doctor can monitor you closely for potential complications. Cardiac rehabilitation specialists from NYU Langone’s Rusk Rehabilitation aid your recovery by helping you to slowly increase your activity level. Most people can walk carefully a day after surgery and remain in the hospital for three to five days.

Your doctor may restrict your activity while you recover at home. This may involve avoiding driving for two weeks after surgery and not traveling to work for a month. During this period, many people work at home.