Septal myectomy for obstructive hypertrophic cardiomyopathy: Comparison of outcomes of the transapical beating-heart and transaortic on-pump approaches.

Background: Transaortic on-pump septal myectomy (SM) is the established standard for surgical septal reduction, but transapical beating-heart SM recently has emerged as a less invasive alternative. This study compares the early outcomes of these 2 approaches to performing SM in patients with obstructive hypertrophic cardiomyopathy (oHCM). Methods: We analyzed the outcomes of 200 consecutive patients undergoing transapical beating-heart myectomy and 200 patients receiving transaortic on-pump myectomy. The primary outcome was procedural success, defined as a peak left ventricular outflow tract (LVOT) gradient <30 mm Hg on predismissal echocardiography. Secondary outcomes included transfusion and postoperative atrial fibrillation rates and intensive care unit (ICU) length of stay. Results: Both techniques significantly reduced LVOT gradient (median reduction: transapical, 102 mm Hg to 15 mm Hg; transaortic, 88 mm Hg to 12 mm Hg; Conclusions: Transapical beating-heart SM provides comparable hemodynamic outcomes to transaortic on-pump myectomy with advantages in ICU recovery time, transfusion rates, and postoperative atrial fibrillation. It may be a viable, less invasive alternative for selected oHCM patients. Further studies, including randomized trials, are needed to assess long-term outcomes.