Results of operation for obstructive hypertrophic cardiomyopathy in the elderly. Septal myotomy and myectomy in 20 patients 65 years of age or older.

The results of operative treatment in 20 patients with hypertrophic cardiomyopathy 65 years of age or older are described. All 20 patients were severely symptomatic before operation. Seventeen of the 20 patients had marked left ventricular outflow tract obstruction under basal conditions (average pressure gradient 107 mm Hg); the other three patients had outflow gradients of more than 50 mm Hg only with provocation. One patient died at operation, and one died 4 years after operation of circumstances unrelated to hypertrophic cardiomyopathy. Sixteen of the 18 long-term survivors have had persistent and significant functional improvement for up to 6 years after operation, including 7 patients who are now asymptomatic. Two patients experienced symptomatic deterioration after manifesting initial symptomatic improvement for 3 and 4 years, respectively, after operation. Operation resulted in a marked decrease or abolition of the left ventricular outflow gradient in each of the 17 patients studied with postoperative cardiac catheterization. These data show that gratifying symptomatic and hemodynamic improvement may be obtained by septal myotomy and myectomy in the elderly patient with hypertrophic cardiomyopathy. Accordingly, advanced age in itself is not a contraindication to operative intervention in such patients.