Surgical therapy of hypertrophic obstructive cardiomyopathy (HOCM)

Hypertrophic obstructive cardiomyopathy is a primary disease of the myocardium with a dynamic systolic narrowing of the left ventricular outflow tract cross-sectional area. In symptomatic patients and/or with significant left ventricular outflow tract gradient surgical therapy is indicated and leads to safe and lasting relief of the left ventricle. Myectomy is always performed transaortic, and with insertion of a sharp triple hook retractor the amount of tissue, which is to be resected, is clearly defined. Extended myectomy to the lateral wall and to the deeper parts of the ventricle allows for safe access to the left ventricle where mobilisation and partial resection of the papillary muscles corrects the anteposition of papillary muscles and abolish SAM and mitral regurgitation. Excellent long-term results with respect to complications or mortality give the surgical approach compared to alcoholic septal ablation still the status of a gold standard.