Treating HOCM: How Surgery Can Help a “Thick” Heart
A surgical procedure called a septal myectomy can provide a safe, long-lasting solution for patients with hypertrophic obstructive cardiomyopathy, or HOCM.
You’ve heard of people having a big heart, but a heart with thick walls is a different thing requiring a different kind of medical attention.
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While thick heart muscle may sound like a good thing, the thickened heart muscle in people with hypertrophic obstructive cardiomyopathy (HOCM) disease can hinder blood flow from the heart through the left ventricular outflow tract (LVOT) and out to the rest of the body. It has been shown that cutting away the excess heart tissue gives relief to patients with this problem.
Some people who have HOCM find relief in medications. For others, a surgical procedure called septal myectomy can provide a safe, lasting solution. This surgery has been done for decades and studies quantify the treatment’s historic success.
Cardiologist Milind Desai, MD, explains that by using various imaging technologies, surgeons can clearly see where the heart muscle creates obstructions in blood flow and can precisely cut the excess tissue away. “In the vast majority of cases, it provides complete relief of outflow tract obstruction as we can remove the right amount of muscle, directed by imaging,” says Dr. Desai. “In some cases, excess mitral valve tissue contributes to this obstructive phenomenon and requires that it be trimmed simultaneously.”
Septal myectomy is open-heart surgery. “Recovery time from most open-heart surgeries (including this one) is about six to eight weeks,” says Dr. Desai. But once you recover, you won’t need to return to surgery. “In the vast majority of cases, this is a one-time thing…the muscle does not grow back,” he says.
A recent study conducted by Cleveland Clinic and published in Circulation confirms that septal myectomy is safe, effective and provides long-lasting relief for patients with HOCM.
Dr. Desai was the lead and corresponding author of the study, which looked at 699 adult patients who underwent septal myectomy (with or without mitral valve repair) to treat LVOT obstruction.
The results show high rates of success, very low morbidity and low rates of complication associated with the procedure. Dr. Desai confirms, “The long-term outcomes of myectomy, with or without additional mitral valve procedures, are excellent.”
Dr. Desai is on the steering and oversight committee for an international multicenter research team that has recently been awarded a new grant from the National Institutes of Health (NIH) to continue the study of HOCM. This $14.4 million grant, one of the largest of its kind, will allow researchers to further study the causes behind HOCM (using imaging techniques like echocardiography, magnetic resonance imaging and genetic testing) and treatment options for patients with HOCM.