Septal myectomy is a type of open-heart surgery for hypertrophic cardiomyopathy (thick heart muscle). It decreases symptoms of the condition.
A muscular wall called the septum separates the left and right ventricles, the 2 lower chambers of the heart. In hypertrophic cardiomyopathy, the walls of the ventricles and septum may thicken abnormally. The septum may bulge into the left ventricle and partially block the blood flow out to the body. This causes the heart to work harder. It also contributes to many symptoms of the disease, such as fatigue and shortness of breath.
During septal myectomy, a surgeon removes excess muscle from the thickened septum. This allows the blood to empty from the ventricle more easily.
Alcohol septal ablation is another option for treating cardiomyopathy. In alcohol septal ablation, the doctor injects alcohol into a blood vessel in the ventricular septum. This causes some of the heart muscle cells to die, making the septum thinner. Alcohol septal ablation is not open-heart surgery, so recovery from the procedure is much easier. But it may have a slightly increased risk of certain complications, such as heart rhythm problems.
In many cases, medicines are enough to relieve symptoms of hypertrophic cardiomyopathy. If symptoms are not relieved with medicines, a procedure such as septal myectomy is often effective.
Septal myectomy is a relatively safe surgical procedure that surgeons have done for many years. Some women with hypertrophic cardiomyopathy also might need a septal myectomy before becoming pregnant, even if their symptoms aren’t severe.
Talk with your doctor to find out if you are a good candidate for either septal myectomy or alcohol septal ablation. Review the risks and benefits of each procedure with your doctor. Surgery is often preferable in younger people and those people with more severe thickening. You might have septal anatomy that is better suited to surgery. You might need additional work done on the heart, like repair of the mitral valve. In these cases, septal myectomy is preferable.
The risks of complications from septal myectomy are low, but they do sometimes happen. Your particular risks will vary based on your age and other factors. Talk with your doctor about any concerns that you have. Some possible complications include:
- Irregular heart rhythms, such as heart block
- Blood clots leading to stroke or heart attack
- Complications from anesthesia
- Aortic valve problems due to movement of the valve in surgery
- Removal of too much heart muscle
- Blood flow problems during surgery that can lead to poor pumping function of the heart in the future
Heart block is a common complication. Heart block is a disruption to the electrical signals through the heart. This can cause your heart to skip beats or beat too slowly. Certain kinds of heart block require treatment with a pacemaker.
Certain factors increase the risk of complications. Some of these are as follows:
- Chronic illness
- Other heart conditions
- Lung problems
- Increased age
- Being obese
- Being a smoker
Talk with your doctor about how to prepare for your upcoming surgery. Remember the following:
- Avoid eating or drinking anything after midnight before your surgery.
- Try to stop smoking before your operation. Ask your doctor for ways to help.
- You may need to stop taking certain medicines before your surgery. Follow your doctor’s instructions if you usually take blood-thinning medicines like warfarin or aspirin.
You may need to arrive at the hospital the afternoon before your operation. This is a good time to ask any questions you have about the procedure. You may need some routine tests before the procedure to assess your health before surgery. These may include:
- Chest X-ray
- Electrocardiogram (ECG)
- Blood tests
- Cardiac catheterization
If needed, someone will shave your skin above the area of operation. About an hour before the operation, someone will give you medicines to help you relax. In most cases, your surgery will proceed as planned, but sometimes another emergency might delay your operation.
Check with your doctor about the details of your procedure. In general, during your septal myectomy:
- A doctor will give you anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly during the operation. Afterwards you won’t remember it.
- The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
- Your surgeon will make an incision down the middle of your chest and separate part of your breastbone.
- The surgery team will attach you to a heart-lung machine. This machine will provide oxygen to your blood and pump the blood to your body during your surgery.
- Your surgeon will cut away part of your thickened septum.
- The surgery team will remove the heart-lung machine.
- The team will wire your breastbone back together.
- The team will then sew or staple the incision in your skin back together.
After your septal myectomy:
- When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
- Most people who have septal myectomy notice immediate symptom relief.
- The team will carefully monitor your vital signs, such as your heart rate. They may hook you up to several machines so the nurses can check these more easily.
- You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. Someone will usually remove the tube within 24 hours.
- You may have a chest tube to drain excess fluid from your chest.
- Bandages will cover your incision. These usually can come off within a couple of days.
- You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you can ask for pain medication.
- In a day or two, you should be able to sit in a chair and walk with help.
- You may perform breathing therapy to help remove fluids that collect in your lungs during surgery.
- You will probably be able to drink liquids the day after surgery. You can have regular foods as soon as you can tolerate them.
- You may receive elastic stockings to help blood circulate through your leg veins.
- You will probably need to stay in the hospital around 5 days.
After you leave the hospital:
- Make sure you have someone to drive you home from the hospital. You will also need some help at home for a while.
- You will probably have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
- You may tire easily after the surgery, but you will gradually start to recover your strength. Recovery time varies, but it will be at least several weeks.
- After you go home, take your temperature and your weight every day. Tell your doctor if your temperature is over 100.4°F (38˚C), or if your weight changes.
- Ask your doctor when it is safe for you to drive.
- Avoid lifting anything heavy for several weeks. Ask your doctor about what is safe for you to lift.
- Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Hypertrophic cardiomyopathy: Nonpharmacologic treatment of left ventricular outflow tract obstruction, Up To Date, What happens after heart surgery? American Heart Association, http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300445.pdf
Sudheendra, Deepak, MD,Petersen, Sheralee, MPAS, PA-C