Septal myectomy for hypertrophic cardiomyopathy: important surgical knowledge and technical tips in the era of increasing alcohol septal ablation.

Hypertrophic cardiomyopathy (HCM) is the most commonly inherited cardiac disease-recent studies suggest a prevalence as high as 1 in 200. For symptomatic patients with obstructive HCM who are refractory to medical therapy, septal reduction is indicated. Septal myectomy (SM) is considered the gold standard septal reduction technique. However, due to a shortage of surgeons who are experienced in this technique, alcohol septal ablation (ASA) has overtaken SM as the most commonly performed procedure for obstructive HCM. In this review, we summarize the existing literature comparing SM with ASA and describe recent innovations in operative technique, including a detailed description of the approach used at our institution.