Heart failure & cardiomyopathies
Transapical Beating-Heart Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy: Lessons Learned After the Learning Curve Period
Authors' conclusion
With real-time echocardiographic guidance, the individualized TA-BSM approach can effectively and safely achieve adequate and precise resections of septal myocardium. The technique’s midterm results further confirmed its therapeutic advantages, potentially broadening the applicability of surgical septal reduction in obstructive hypertrophic cardiomyopathy treatment.
Study context
- Population
- Patients with heterogeneous anatomic presentations of obstructive hypertrophic cardiomyopathy undergoing TA-BSM, January 2023 to January 2024, immediately after the learning curve periodpatients who underwent TA-BSM
- Participants
- 418 patients
- Outcome
- Procedural success (resting/provoked left ventricular outflow tract gradient <30/50 mm Hg and mitral regurgitation ≤grade 2+ (of 4+))
- Follow-up
- 3- to 6-month follow-up
Main finding
As reported in the abstract
TA-BSM
91.1%
Observational data: associations, not effects.
Further findings
Maximal left ventricular outflow tract gradient · preoperatively and at 3- to 6-month follow-up
mm Hg
- Preoperative, median
- 85 (interquartile range, 65-114)
- 3- to 6-month follow-up, median
- 19 (interquartile range, 12-28)
Mitral regurgitation ≤grade 2+ · preoperatively and upon follow-up
- Upon follow-up
- 98.8%
- Preoperatively
- 47.7%
Estimated 1-year survival · median follow-up 310 (interquartile range, 207-408) days
- Estimated 1-year survival
- 98.7% (95% CI, 97.6%-99.9%)
Safety
Major adverse events
- Left ventricular apical tear
- n=3, 0.7%
- Iatrogenic mitral valve injury
- n=3, 0.7%
- Permanent pacemaker implantation
- n=10, 2.4%
- Transient ischemic stroke
- n=2, 0.5%
- All affected patients recovered uneventfully.
30-day mortality
- 30-day mortality
- 0.2% (n=1)
Original publication
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