Gordon Fox • September 29, 2022
Septal Myectomy Today

What’s the status of septal myectomy today? A recent review paper by an Expert Panel for the American Journal of Cardiology ( Maron et al. 2022 ) concludes that “Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction.”

One of the safest of heart procedures

Septal myectomy – especially at high-volume centers – is one of the safest of heart procedures, and has a strong record of safely improving patient’s symptoms of heart failure. The authors review alternatives – useful especially in those who are poor surgical candidates – and drug treatments. Myectomy is used in those who are unresponsive to drug therapy.

What about myosin inhibitors?

Does the emergence of the new myosin-inhibiting drugs ( Camzyos , and others being tested) change this? No, the authors conclude. There will continue to be patients who will not respond to these drugs, or who cannot handle their considerable financial burden. Nor is it yet known whether myosin inhibitors will succeed as lifelong treatments; they may turn out to often be most useful in helping patients delay myectomy.

Conclusion

The authors emphasize that “As new medical initiatives emerge, it is particularly important to underscore the effectiveness of septal myectomy in the State-of-the-Art management of severely symptomatic obstructive HCM patients, careful to avoid delay or under-utilization of operative intervention.”

Literature cited

Maron, B. J., Dearani, J. A., Smedira, N. G., Schaff, H. V., Wang, S., Rastegar, H., Ralph-Edwards, A., Ferrazzi, P., Swistel, D., Shemin, R. J., Quintana, E., Bannon, P. G., Shekar, P. S., Desai, M., Roberts, W. C., Lever, H. M., Adler, A., Rakowski, H., Spirito, P., Nishimura, R. A., Ommen, S. R., Sherrid, M. V., Rowin, E. J., and Maron, M. S. 2022. Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel. The American Journal of Cardiology 180: 124–139. https://doi.org/10.1016/j.amjcard.2022.06.007

HCMA Blog

April 30, 2025
Medical Management means using medicines and other non-invasive therapies to relieve symptoms. It's exciting that new treatments for HCM are being studied and that the FDA approved Camzyos in 2022! HCM can cause various symptoms depending on how stiff the heart is, how much scarring (fibrosis) there is, and whether there is obstruction. Some people have no noticeable symptoms. Common symptoms are chest pain/pressure, shortness of breath, lightheadedness, fatigue, palpitations, and brain fog. Syncope (fainting) is dramatic but not as common as the other symptoms. Medications are the first-line treatment for symptoms of HCM. If patients can't take one class of medication, they can try a medication from a different class. Here are some medications used to treat HCM and what they're for: Beta Blockers - make your heart beat slower and relax better. They allow the heart to fill more completely between beats. They can lower blood pressure and relieve symptoms. Calcium Channel Blockers - used to lower blood pressure and slow the heart rate. May reduce symptoms from obstruction in HCM. Myosin Inhibitors - cause the heart to beat with less force. They may reduce obstruction and septal thickness in some patients. Camzyos (mavacamten) is the first of this class of medication. For more information, click HERE . Antiarrhythmics - help to restore normal rhythm in the heart. Blood Thinners - anticoagulants and anti-platelets make it harder for blood to clot. They are prescribed to reduce the risk of stroke. This risk is higher in patients with afib, aflutter, and artificial heart valves. Diuretics , or "water pills," help the kidneys get rid of extra water and salt, reducing swelling in the body. Sodium Channel Blockers - may reduce gradient in obstructive HCM and can treat chest pain. Some also act as antiarrhythmics. Antibiotics - treat or prevent bacterial infections. In HCM, they may be given before dental work to prevent infective endocarditis. To learn more and see the side effects of these medications, click HERE .
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