{"doi":"10.1016/j.amjcard.2022.02.035","title":"Sixty-Year Evolution of Surgical Myectomy for Symptomatic Obstructive Hypertrophic Cardiomyopathy with Insights From the Historic NIH Surgical Experience to Present","abstract":"Since virtually from the modern conception of hypertrophic cardiomyopathy in the early 1960s, surgical septal myectomy has been the primary “gold standard” treatment to reverse drug-refractory heart failure symptoms by permanent and complete relief of left ventricular (LV) outflow obstruction.1Ommen SR Mital S Burke MA. et al.2020 AHA/ACC Guidelines for the diagnosis and treatment of patients with hypertrophic cardiomyopathy.J Am Coll Cardiol. 2020; 76: e159-e240Crossref PubMed Scopus (258) Google Scholar,2Braunwald E Labrew E Rockoff D. Idiopathic hypertrophic subaortic stenosis. A description of the disease based upon an analysis of 64 patients.Circulation. 1964; 30: 1-217Google Scholar However, despite this long time period, myectomy studies have generally reported follow-up data over relatively short periods with few assessments of treatment outcomes across multiple management eras.3Kotkar KD Said SM Dearani JA Schaff HV. Hypertrophic obstructive cardiomyopathy: The Mayo Clinic experience.Ann Cardiothorac Surg. 2017; 6: 829-836Crossref Scopus (54) Google Scholar, 4Woo A Williams WG Choi R. et al.Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy.Circulation. 2005; 111: 2033-2041Crossref PubMed Scopus (274) Google Scholar, 5Desai MY Bhonsale A Smedira NG. et al.Predictors of long-term outcomes in symptomatic hypertrophic cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction.Circulation. 2013; 128: 209-216Crossref PubMed Scopus (150) Google Scholar Therefore, in this Viewpoint we have taken the unique opportunity to compare truly long-term survival outcomes of the historic surgical myectomy series of Dr. Andrew G. Morrow at NIH Bethesda, MD [the pioneer credited with initial design and implementation of this operation6Morrow AG Brockenbrough EC. Surgical treatment of idiopathic hypertrophic subaortic stenosis: technic and hemodynamic results of subaortic ventriculotomy.Ann Surg. 1961; 154: 181-189Crossref PubMed Scopus (171) Google Scholar] with an example of more contemporary surgical results, and in the process demonstrating evolution of the myectomy operation. NIH Cohort. Over 22 years (1960-1982), Dr. Morrow performed 343 myectomy operations on patients with obstructive hypertrophic cardiomyopathy who were severely disabled by heart failure symptoms due to peak systolic pressure gradients ≥50 mmHg measured at cardiac catheterization.6Morrow AG Brockenbrough EC. Surgical treatment of idiopathic hypertrophic subaortic stenosis: technic and hemodynamic results of subaortic ventriculotomy.Ann Surg. 1961; 154: 181-189Crossref PubMed Scopus (171) Google Scholar One of the co-authors of this paper (EB) was closely involved in the selection of patients for operation,7Braunwald E Morrow AG. Obstruction to left ventricular outflow: current criteria for the selection of patients.Am J Cardiol. 1963; 12: 53-59Abstract Full Text PDF PubMed Scopus (13) Google Scholar as well as their cardiology care, representing an early example of a comprehensive “heart team” approach to complex interventional cardiovascular care. Medical records were accessible through the NIH Clinical Center. Survival status and age of death was confirmed by interrogation of the Social Security Death Index and Lexis Nexis®. Postoperative follow-up duration was 17 ± 11 years (range to 52). Fourteen patients (4%) died in the immediate postoperative period and 80 patients were lost to follow-up. Of the 249 NIH patients also comprise the study group, age at operation was 48 ± 14 years (range 8 - 76); 55% were male. Over follow-up, survival was to: ≥60 years (163; 66%); including 60-69 years (59; 24%); 70-79 (66; 27%), and ≥80 years (38; 15%). Also, 60 patients (24%) have survived 25 years and 136 (55%) ≥15 years. Survival post-myectomy from all causes was 67% (95% CI: 61,73) at 10 years; 55%, (95% CI: 48, 60) at 15 years; and 24% (95% CI: 19, 30)","journal":"The American Journal of Cardiology","year":2022,"id":279149,"datarank":0.26876392038420827,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.0,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.949,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":290485,"name":"Douglas R. Rosing","orcid":null,"position":1,"is_corresponding":false},{"id":2019,"name":"Eugene Braunwald","orcid":"0000-0002-3472-626X","position":2,"is_corresponding":false},{"id":723387,"name":"Hassan Rastegar","orcid":"0000-0001-8318-5175","position":3,"is_corresponding":false},{"id":536948,"name":"Benjamin Koethe","orcid":"0000-0001-8019-181X","position":4,"is_corresponding":false},{"id":952180,"name":"William C. Roberts","orcid":"0000-0001-7735-5641","position":5,"is_corresponding":false},{"id":402510,"name":"Barry J. Maron","orcid":"0000-0002-1710-8670","position":6,"is_corresponding":false},{"id":640132,"name":"Ethan J. Rowin","orcid":"0000-0002-3953-0143","position":7,"is_corresponding":false},{"id":618307,"name":"Martin S. Maron","orcid":"0000-0002-9923-3853","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T00:28:51.322666Z","pmid":"35361474","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}