Septal myectomy is an open heart surgery during which a portion of thickened heart muscle that’s blocking blood from flowing out of the heart is removed.
“It’s the gold standard for many patients,” says Dr. Makkiya.
During septal myectomy, you’re placed under general anesthesia and connected to a cardiopulmonary bypass machine to take over the work of your heart and lungs. Your surgeon makes a large incision down the center of your chest and uses a blade to remove the thickened portion of tissue from your heart. You’re then disconnected from the cardiopulmonary bypass machine and your surgeon closes your incision with absorbable stitches.
The procedure typically takes three to four hours, followed by about five days of recovery in the hospital. Most people fully recover within six to eight weeks.
Why Septal Myectomy Works
Reducing or eliminating a blockage makes it easier for your heart to send blood to the rest of your body. As a result, almost all patients experience a major difference in symptoms like shortness of breath, chest pain, fainting, or lightheadedness.
“Patients usually feel significantly better almost immediately,” says Sandeep Jani, MD, MPH, the associate director of advanced heart failure and population health at MedStar Heart and Vascular Institute in Baltimore.
There are long-term benefits, too. Studies show that obstructive HCM patients who undergo septal myectomy have higher long-term survival rates than those who don’t have surgery.
Septal myectomy is generally considered a safe procedure. But as with all open-heart surgeries, it comes with some risks, including fluid buildup around the heart or lungs, atrial fibrillation, or disruptions to the heart’s electrical system. Ideally, you can have this procedure at a facility that is extremely familiar with it. Undergoing surgery at a hospital that performs more than 10 myectomies per year is tied to lower rates of complications, research shows.
Who Is Septal Myectomy For?
Septal myectomy can be an option if medications alone aren’t doing enough to manage your obstructive HCM. In general, it’s more likely to be recommended for younger patients who are at low risk of complications from open-heart surgery, says Dr. Jani.
The decision to undergo septal myectomy is highly individualized. Talk with the members of your cardiology care team, including your cardiologist, imaging specialist, and surgeon, to weigh the benefits and risks and make the best choice for you.