Abstract
There is increasing attention to the contemporary management of hypertrophic cardiomyopathy (HCM), particularly the consequences of obstruction to left ventricular (LV) outflow recognized as largely responsible for heart failure-related limiting symptoms. In this regard, 60-year-old trans aortic surgical myectomy (among the oldest of the open heart operations) has stood the test of time, surviving several major challenges over this extended period, including excessive early mortality, introduction of alcohol septal ablation, dual-chamber pacing, and most recently cardiac myosin/inhibitors. However, myectomy remains a highly effective strategy due to permanent and complete relief of subaortic obstruction and normalization of LV pressure with low operative mortality (≤ 0.5%/year) at experienced centers. As a result, > 90% of operated patients achieve significant relief of disabling heart failure-related symptoms, including restoration of normal daily activity. Myectomy therefore provides young patients with decades of unrestricted lifestyle during which the advantages of surgery can be realized, as well as a long-term survival benefit (including possibly reduced sudden death risk) comparable to an age- and sex-matched general population, offering patients the reasonable expectation for normal if not extended life expectancy with good quality of life.