What to Expect from Hypertrophic Cardiomyopathy Surgery

Hypertrophic Cardiomyopathy

Patients with hypertrophic cardiomyopathy (CM) may require a surgery called septal myectomy to reduce the thickening of the heart muscle, which obstructs blood flow.

A septal myectomy is an open-heart surgery where a cardiologist removes part of the thickened heart wall to improve blood flow.

Some individuals will need an additional surgery called a mitral valve repair, which is typically performed at the same time as a septal myectomy.

For patients who are not healthy enough for a septal myectomy, alcohol septal ablation is an effective alternative treatment.

If you have hypertrophic cardiomyopathy and your healthcare provider has recommended surgery, you may be concerned about what to expect.

Any surgery can be daunting, but open-heart surgery can be especially worrying.

However, surgery is one of the most effective ways to treat hypertrophic cardiomyopathy and its symptoms.

As hypertrophic cardiomyopathy can significantly impact your quality of life, surgery is a good option for symptom relief. This may help you live a life free of unpleasant and uncomfortable symptoms.

What is a Septal Myectomy?

A septal myectomy is a surgical procedure often recommended to patients with hypertrophic cardiomyopathy.

This is the most common surgery used to treat the condition.

Who should get a septal myectomy?

Patients who have been prescribed medication and don’t see a significant improvement in their symptoms may be candidates for septal myectomy.

Typically, individuals with hypertrophic cardiomyopathy who have a severely thickened heart muscle will require surgery.

How does a septal myectomy surgery work?

In those with hypertrophic cardiomyopathy, the wall between the left and right sides of the heart thickens and prevents proper blood flow.

A septal myectomy involves thinning the wall between the two sides of the heart to enhance blood flow and heart function.

During this procedure, the surgeon creates a six to eight-inch chest incision and separates the breastbone to get a clear visualization of the heart. This allows access to the septum, where they surgically remove a portion of the thickened muscle wall.

The procedure aims to expand the left ventricle, enhancing blood flow to the aortic valve and improving overall heart function.

This decreases the strain on the mitral valve, which is responsible for keeping blood flowing in the right direction.

A heart-lung machine is used to keep the heart still during the procedure. This machine does the work of the heart and lungs, allowing surgeons to operate under stable and controlled conditions.

Is a septal myectomy effective?

As a septal myectomy is an open-heart procedure, it is a serious surgery. Due to its complexity, patients may need several weeks of recovery time.

However, a septal myectomy is considered an effective treatment for hypertrophic cardiomyopathy as it can significantly improve related symptoms by thinning the heart muscle.

What are the benefits of having a septal myectomy?

Individuals who experience severe symptoms that are affecting their quality of life may find a septal myectomy highly beneficial, especially if medication isn’t working effectively.

A septal myectomy can relieve symptoms such as:

  • Chest pain

  • Fatigue

  • Shortness of breath

  • Fainting

  • Swelling

What are the risks of a septal myectomy?

As with any surgical procedure, there are some risks involved in this surgery. While these complications are rare, the risks include:

  • Infection

  • Fluid buildup around the heart or lungs

  • Bleeding or blood clotting

  • Heart rhythm problems (arrhythmias)

How long does the surgery take?

A septal myectomy usually takes about three to four hours, with patients receiving general anesthesia for sedation during the procedure.

What Happens Before a Septal Myectomy?

Prior to the surgery, your doctor will give you specific instructions to follow in the days leading up to the procedure.

This may include not eating for some time before the surgery and stopping certain medications like blood thinners.

Before your surgery, your healthcare provider may conduct various tests, including X-rays, echocardiograms (ultrasound of the heart), and blood tests to ensure you are ready for the procedure.

What Happens after a Septal Myectomy?

After a septal myectomy, patients are often placed in an intensive care unit (ICU) for 24 hours for close monitoring.

This is to ensure there are no complications following the procedure. Depending on the individual, patients may need to remain in a hospital for up to a week.

You may have a urine catheter inserted post-surgery, as the inability to urinate is often a side effect of anesthesia.

It’s also likely that you’ll have a chest drainage tube for up to 48 hours after the surgery to prevent the accumulation of excess fluid buildup.

While in the hospital, patients may work with rehabilitation specialists or physiotherapists to aid in post-surgery recovery.

Your activity in the hospital will gradually increase until discharge, with most patients able to walk the day after surgery, guided by the surgeon's advice on activity levels.

Key Point: How Will I Feel After a Septal Myectomy?

Most patients experience relief from hypertrophic cardiomyopathy symptoms within the first few days of having the surgery. However, it may take weeks for symptoms to resolve completely.

Individuals may have some pain in the chest, but this shouldn’t be severe.

After surgery, patients may initially experience quicker fatigue than usual, but this is normally temporary. Regular energy levels are usually regained within a few weeks.

Once you are discharged from the hospital and begin recovering at home, be sure to monitor your symptoms.

You should contact your doctor if you experience any of the symptoms below, which could indicate complications:

  • Excessive weight gain

  • A fever higher than 100.4°F

  • Warmth, redness, or swelling around the incision

How to Reduce the Risk of Septal Myectomy Complications at Home

Your doctor will give you specific post-operative care and recovery instructions, which are crucial to follow for a smooth recovery process.

There are some simple lifestyle changes you can make to ensure you recover well from the surgery and that you don’t develop any complications. These include:

  • Physical activity: After the surgery, it’s important that you stick to the exercise guidelines provided by your physician or physiotherapist.

  • Diet: There may be certain foods you should avoid post-surgery. You can consult a nutritionist to find out what you should be eating for optimal recovery.

  • Maintaining a healthy weight: This prevents extra stress on the heart. It can also reduce other health-related risks involved with the surgery.

  • Avoid alcohol: Alcoholic drinks significantly impact the heart and may cause irregular rhythms while recovering from surgery.

  • Regular checkups: Your doctor will likely set up a series of appointments post-surgery to monitor your recovery and ensure there aren’t any complications. Make sure you attend all your follow-ups.

Will I Need Any Other Surgeries?

Many patients who receive a septal myectomy may also need a procedure called a mitral valve repair.

The mitral valve acts as a gateway between the upper left chamber — which receives blood from the lungs — and the lower left chamber — which pumps blood to the body through the aorta.

Hypertrophic cardiomyopathy can cause obstructions in the heart, potentially stretching and damaging the mitral valve. This occurs due to the increased strain on the valve as it works harder to pump blood effectively.

The mitral valve can either be repaired or replaced. Your surgeon will make this decision. Often, this procedure will take place during a septal myectomy.

Are There Alternatives to Septal Myectomy Surgery?

Some patients aren’t eligible for a septal myectomy, such as those who aren’t healthy enough to have surgery.

Others may prefer to try alternative treatments before undergoing surgery. In these scenarios, doctors may recommend alcohol septal ablation.

What is alcohol septal ablation?

Alcohol septal ablation is a minimally invasive treatment for heart diseases such as hypertrophic cardiomyopathy.

It involves a doctor injecting medical ethanol into the blood vessel that supplies blood to the septum.

What happens during alcohol septal ablation?

A specialist called an interventional cardiologist will make an incision in the groin or wrist and then insert a tube called a catheter into a blood vessel.

They will then use an X-ray to help them guide the catheter to the artery that supplies blood to the septum.

Alcohol is injected through the catheter, which is then removed, and the incision site is closed.

The injected alcohol causes the thickened heart muscle to shrink, with the objective being to improve blood flow. The procedure typically takes one to two hours to complete.

In some cases, to prevent a slow heart rate (bradycardia), doctors may implant a temporary pacemaker for a few days to regulate the heart's rhythm.

Patients remain awake during alcohol septal ablation, but they may receive a mild sedative to remain calm and comfortable.

Recovery after alcohol septal ablation

As this isn’t an open heart surgery, patients typically recover quickly from this procedure and with fewer complications.

Some individuals may remain in the hospital for up to 72 hours for monitoring after alcohol septal ablation.

Typically, patients experience significant symptom relief after the procedure.

Your healthcare provider will likely instruct you when and how to resume normal activities once you’re discharged.

However, you should be able to get back to your daily activity levels within one to two weeks.

Where Can I Learn More About Hypertrophic Cardiomyopathy Surgery?

If you have any questions about surgeries for hypertrophic cardiomyopathy or other cardiovascular issues, book an online consultation through LifeMD.

LifeMD can connect you to a team of medical professionals who can answer your questions and provide treatment recommendations for your condition.

Make your appointment today to get started.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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