Surgical myectomy for hypertrophic cardiomyopathy: Procedural volume and outcomes

Tijn J.P. Heeringa; Romy M.J.J. Hegeman; Yvonne Koop; Sulayman el Mathari; Marieke Hoogewerf; Maaike M. Roefs; Karin C. Smits; Dorien Laenens; Giulia De Zan; Maarten J. Cramer; Marco Guglielmo; Pim van der Harst; Ilonca Vaartjes; Mostafa M. Mokhles; Patrick Klein; Niels P. van der Kaaij; SAM-Registry Study Investigators; Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration; F.R. Halfwerk

doi:10.1093/eurheartj/ehaf560

Surgical myectomy for hypertrophic cardiomyopathy: Procedural volume and outcomes

Tijn J.P. Heeringa
, Romy M.J.J. Hegeman
, Yvonne Koop
, Sulayman el Mathari
, Marieke Hoogewerf
, Maaike M. Roefs
, Karin C. Smits
, Dorien Laenens
, Giulia De Zan
, Maarten J. Cramer
, Marco Guglielmo
, Pim van der Harst
, Ilonca Vaartjes
, Mostafa M. Mokhles
, Patrick Klein
, Niels P. van der Kaaij^*
, SAM-Registry Study Investigators
, Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration
, F.R. Halfwerk

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background and aims: Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates.

Methods: All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate.

Results: Isolated surgical myectomy was performed in 22%, surgical myectomy with one concomitant procedure in 54%, and surgical myectomy with two or more concomitant procedures in 24%. Thirty-day complication rates concerned mortality (5%), ventricular septal defect (2%), stroke (3%), and surgical reoperation (2%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 ± 30 mmHg to 13 ± 12 mmHg postoperatively, systolic anterior motion from 80% to 8%, and mitral regurgitation grade 3 or 4 from 31% to 6%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and ≥2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95% confidence interval: 1.43-8.09); P = .007).

Conclusions: Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93% of patients in this multicentre cohort. Female sex, ≥ 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted.

Original language	English
Article number	ehaf560
Number of pages	13
Journal	European heart journal
Early online date	29 Aug 2025
DOIs	https://doi.org/10.1093/eurheartj/ehaf560
Publication status	E-pub ahead of print/First online - 29 Aug 2025

Keywords

Hypertrophic obstructive cardiomyopathy
Heart septum
Surgical volume
Morrow
Echocardiography
Left ventricular outflow obstruction

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10.1093/eurheartj/ehaf560Licence: CC BY

ArticleFinal published version, 1.24 MBLicence: CC BY

Three-dimensional heart modelling of hypertrophic obstructive cardiomyopathy for in situ patient-specific simulation to optimise septal myectomy
Smits, K., Speekenbrink, R. G. H., Hekman, E. E. G., Koenrades, M. A., Heeringa, T., Arens, J. & Halfwerk, F. R. (Corresponding Author), 1 Oct 2024, In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 19, 5, p. 532-540 9 p.
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Heeringa, T. J. P., Hegeman, R. M. J. J., Koop, Y., Mathari, S. E., Hoogewerf, M., Roefs, M. M., Smits, K. C., Laenens, D., De Zan, G., Cramer, M. J., Guglielmo, M., van der Harst, P., Vaartjes, I., Mokhles, M. M., Klein, P., van der Kaaij, N. P., SAM-Registry Study Investigators , Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration, & Halfwerk, F. R. (2025). Surgical myectomy for hypertrophic cardiomyopathy: Procedural volume and outcomes. European heart journal, Article ehaf560. Advance online publication. https://doi.org/10.1093/eurheartj/ehaf560

@article{4fc5cdbc9ba4453d9016516f6354efc9,

title = "Surgical myectomy for hypertrophic cardiomyopathy: Procedural volume and outcomes",

abstract = " Background and aims: Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates. Methods: All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate. Results: Isolated surgical myectomy was performed in 22\%, surgical myectomy with one concomitant procedure in 54\%, and surgical myectomy with two or more concomitant procedures in 24\%. Thirty-day complication rates concerned mortality (5\%), ventricular septal defect (2\%), stroke (3\%), and surgical reoperation (2\%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 ± 30 mmHg to 13 ± 12 mmHg postoperatively, systolic anterior motion from 80\% to 8\%, and mitral regurgitation grade 3 or 4 from 31\% to 6\%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and ≥2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95\% confidence interval: 1.43-8.09); P = .007). Conclusions: Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93\% of patients in this multicentre cohort. Female sex, ≥ 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted. ",

keywords = "Hypertrophic obstructive cardiomyopathy, Heart septum, Surgical volume, Morrow, Echocardiography, Left ventricular outflow obstruction",

author = "Heeringa, \{Tijn J.P.\} and Hegeman, \{Romy M.J.J.\} and Yvonne Koop and Mathari, \{Sulayman el\} and Marieke Hoogewerf and Roefs, \{Maaike M.\} and Smits, \{Karin C.\} and Dorien Laenens and \{De Zan\}, Giulia and Cramer, \{Maarten J.\} and Marco Guglielmo and \{van der Harst\}, Pim and Ilonca Vaartjes and Mokhles, \{Mostafa M.\} and Patrick Klein and \{van der Kaaij\}, \{Niels P.\} and \{SAM-Registry Study Investigators\} and \{Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration\} and J. Kluin and M. Palmen and R.G.H. Speekenbrink and F.R. Halfwerk and A. Yazdanbakhsh and \{van Garsse\}, L.A.F.M. and R.C.A. Meijer and N.P.A. Zuithoff and S. Bramer and \{de Lind van Wijngaarden\}, R.A.F. and B.M.J.A. Koene and J.A. Bekkers and G.J.F. Hoohenkerk and A.L.P. Markou and \{de Weger\}, A. and P. Segers and D. Stecher and R.G.H. Speekenbrink and V.G. Hindori and W.W.L. Li and E.J. Daeter and M.M. Mokhles and Y.L. Douglas",

note = "{\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2025",

month = aug,

day = "29",

doi = "10.1093/eurheartj/ehaf560",

language = "English",

journal = "European heart journal",

issn = "0195-668X",

publisher = "Oxford University Press",

}

Heeringa, TJP, Hegeman, RMJJ, Koop, Y, Mathari, SE, Hoogewerf, M, Roefs, MM, Smits, KC, Laenens, D, De Zan, G, Cramer, MJ, Guglielmo, M, van der Harst, P, Vaartjes, I, Mokhles, MM, Klein, P, van der Kaaij, NP, SAM-Registry Study Investigators , Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration & Halfwerk, FR 2025, 'Surgical myectomy for hypertrophic cardiomyopathy: Procedural volume and outcomes', European heart journal. https://doi.org/10.1093/eurheartj/ehaf560

TY - JOUR

T1 - Surgical myectomy for hypertrophic cardiomyopathy

T2 - Procedural volume and outcomes

AU - Heeringa, Tijn J.P.

AU - Hegeman, Romy M.J.J.

AU - Koop, Yvonne

AU - Mathari, Sulayman el

AU - Hoogewerf, Marieke

AU - Roefs, Maaike M.

AU - Smits, Karin C.

AU - Laenens, Dorien

AU - De Zan, Giulia

AU - Cramer, Maarten J.

AU - Guglielmo, Marco

AU - van der Harst, Pim

AU - Vaartjes, Ilonca

AU - Mokhles, Mostafa M.

AU - Klein, Patrick

AU - van der Kaaij, Niels P.

AU - SAM-Registry Study Investigators

AU - Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration

AU - Kluin, J.

AU - Palmen, M.

AU - Speekenbrink, R.G.H.

AU - Halfwerk, F.R.

AU - Yazdanbakhsh, A.

AU - van Garsse, L.A.F.M.

AU - Meijer, R.C.A.

AU - Zuithoff, N.P.A.

AU - Bramer, S.

AU - de Lind van Wijngaarden, R.A.F.

AU - Koene, B.M.J.A.

AU - Bekkers, J.A.

AU - Hoohenkerk, G.J.F.

AU - Markou, A.L.P.

AU - de Weger, A.

AU - Segers, P.

AU - Stecher, D.

AU - Speekenbrink, R.G.H.

AU - Hindori, V.G.

AU - Li, W.W.L.

AU - Daeter, E.J.

AU - Mokhles, M.M.

AU - Douglas, Y.L.

PY - 2025/8/29

Y1 - 2025/8/29

N2 - Background and aims: Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates. Methods: All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate. Results: Isolated surgical myectomy was performed in 22%, surgical myectomy with one concomitant procedure in 54%, and surgical myectomy with two or more concomitant procedures in 24%. Thirty-day complication rates concerned mortality (5%), ventricular septal defect (2%), stroke (3%), and surgical reoperation (2%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 ± 30 mmHg to 13 ± 12 mmHg postoperatively, systolic anterior motion from 80% to 8%, and mitral regurgitation grade 3 or 4 from 31% to 6%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and ≥2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95% confidence interval: 1.43-8.09); P = .007). Conclusions: Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93% of patients in this multicentre cohort. Female sex, ≥ 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted.

AB - Background and aims: Outcomes after surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients have not been investigated in a multicentre registry with detailed clinical data. Hence, the objectives of this multicentre Dutch study are to describe the 30-day clinical outcomes after surgical myectomy, and to assess factors associated with increased 30-day complication rates. Methods: All HOCM patients (n = 335) who underwent surgery between 2012 and 2020 across 12 Dutch hospitals were analysed using data from the Netherlands Heart Registration. Multiple logistic regression analyses assessed factors associated with a higher 30-day complication rate. Results: Isolated surgical myectomy was performed in 22%, surgical myectomy with one concomitant procedure in 54%, and surgical myectomy with two or more concomitant procedures in 24%. Thirty-day complication rates concerned mortality (5%), ventricular septal defect (2%), stroke (3%), and surgical reoperation (2%). Mean resting left ventricular outflow tract (LVOT) gradient improved from 61 ± 30 mmHg to 13 ± 12 mmHg postoperatively, systolic anterior motion from 80% to 8%, and mitral regurgitation grade 3 or 4 from 31% to 6%. Low-volume hospital (<10 surgical myectomy procedures/year), female sex, and ≥2 concomitant procedures were significantly associated with increased 30-day complication rates. The adjusted 30-day complication rate was increased in low-volume hospitals (odds ratio 3.23 (95% confidence interval: 1.43-8.09); P = .007). Conclusions: Surgical myectomy with or without concomitant procedures effectively relieved LVOT obstruction in 93% of patients in this multicentre cohort. Female sex, ≥ 2 concomitant procedures, and low-volume hospitals were associated with higher 30-day complication rates. Although an inverse volume-complication relation was observed, this finding should be interpreted cautiously, and further investigation in larger sample size studies is warranted.

KW - Hypertrophic obstructive cardiomyopathy

KW - Heart septum

KW - Surgical volume

KW - Morrow

KW - Echocardiography

KW - Left ventricular outflow obstruction

U2 - 10.1093/eurheartj/ehaf560

DO - 10.1093/eurheartj/ehaf560

M3 - Article

SN - 0195-668X

JO - European heart journal

JF - European heart journal

M1 - ehaf560

ER -

Surgical myectomy for hypertrophic cardiomyopathy: Procedural volume and outcomes

Abstract

Keywords

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Research output

Three-dimensional heart modelling of hypertrophic obstructive cardiomyopathy for in situ patient-specific simulation to optimise septal myectomy

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