Long-term outcomes of obstructive hypertrophic cardiomyopathy undergoing surgical myectomy: impact of symptom severity at presentation

Surgical myectomy (SM), performed to relieve dynamic left ventricular outflow tract obstruction in symptomatic obstructive hypertrophic cardiomyopathy (oHCM) patients, provides improved quality of life and symptoms and excellent long-term survival. Guidelines recommend SM in symptomatic oHCM patients refractory to optimal medical therapy. We sought to assess whether SM in patients with fewer symptoms at initial referral is associated with improved long-term outcomes in oHCM. Baseline symptom burden at the time of referral emerged as a powerful prognostic discriminator among 3546 HCM patients undergoing SM. Our findings suggest that earlier surgical referral before advanced decompensation may be associated with more favourable long-term outcomes. Women were more likely to present with advanced symptoms and had higher adjusted risk. These results underscore the need to determine whether a proactive therapeutic strategy, including an earlier intervention, can modify long-term survival in oHCM.