Names & Terms You Will Hear
Plain-language meanings for the terms your care team may use.
| Term | Meaning |
|---|---|
| Septal myectomy | Open-heart surgery. It removes a small piece of thick heart-muscle wall (the septum) to relieve a blockage. |
| Surgical septal reduction | Another name for the surgery. It trims the thick muscle that blocks blood flow. |
| Morrow procedure | The classic name for this surgery. It is named for the surgeon who described it. |
| Extended transaortic myectomy | The modern version. The surgeon reaches the septum through the aortic valve. |
| Septal reduction therapy (SRT) | The umbrella term. It covers both the surgery and the catheter fix (alcohol ablation). |
| Obstructive HCM (oHCM) | The heart problem this surgery treats. Thick muscle blocks blood from leaving the heart. |
| LVOT obstruction | The blockage itself. LVOT stands for left ventricular outflow tract — the path blood takes to leave the heart. |
Go to an experienced center. Septal myectomy is a specialized operation. Results are much better — and risks much lower — at high-volume HCM centers that do many of these surgeries each year. It is worth traveling for. Ask your cardiologist for a referral to a comprehensive HCM center, and get a Heart Team review.
What Is Septal Myectomy?
- Septal myectomy is open-heart surgery for obstructive hypertrophic cardiomyopathy (oHCM). The surgeon removes a small wedge of thickened muscle from the wall (septum) that blocks blood leaving the heart.
- Taking out that muscle opens the path out of the heart. The blockage drops, and symptoms like shortness of breath, chest pain, and fainting get much better.
- It is the long-standing gold standard for severe symptoms that do not get better with medicine. It works especially well for younger patients and very thick septums.
- The surgery is done through the chest (a sternotomy) while a heart-lung machine takes over for a short time. The surgeon reaches the septum through the aortic valve.
- A Heart Team — a cardiologist and a heart surgeon with HCM experience — helps you choose between myectomy, alcohol septal ablation, and medicine.
- Results are excellent at experienced, high-volume HCM centers. The blockage stays relieved for years, and long-term survival can match the general population.
- This guide pairs with our HCM guide, our alcohol septal ablation guide, and our mavacamten guide.
What the Surgeon Removes (and How It Helps)
- In obstructive HCM, the wall between the two pumping chambers (the septum) is too thick at its base, right below the aortic valve.
- That thick muscle narrows the path out of the heart. When the heart squeezes, it pulls the muscle and a valve flap into the path and blocks flow even more.
- The surgeon removes a small, carefully measured wedge of this thick muscle — usually a few grams.
- Taking out that wedge widens the path out of the heart. Blood now leaves freely, so the pressure across the blockage drops sharply.
- Many patients also have a leaky mitral valve because of the blockage. Once flow is opened up, the leak often improves, or the valve can be repaired in the same surgery.
- The result is much less breathlessness, chest pain, and fainting — and the benefit lasts for years.
Why It Matters
- In obstructive HCM, the thick septum acts like a partly closed door. The heart has to push hard to move blood past it. That causes breathlessness, chest pain, and fainting.
- When medicines are not enough, relieving the blockage is the goal. Myectomy removes the cause rather than just easing the symptoms.
- Surgery is usually offered when the blockage is severe (a gradient of 50 mmHg or higher) and symptoms are limiting daily life despite the best medicines.
- Where you have it matters. High-volume HCM centers have very low risk and durable results. Low-volume centers have higher complication rates. This is one of the clearest examples in heart care.
- Newer medicine called mavacamten (Camzyos) may let some patients put off or avoid surgery. The Heart Team weighs this for each person.
- HCM runs in families. After your diagnosis, close relatives should be checked — see our genetic testing guide.
Risk Factors
Knowing your personal risks helps your care team take extra precautions.
| Risk Factor | Why It Increases Risk |
|---|---|
| Severe symptoms despite medicine | You still have bad breathlessness, chest pain, or fainting on the best medicines. This points toward a procedure. |
| High outflow gradient (50 mmHg or more) | A large pressure difference across the blockage means the obstruction is severe. |
| Very thick septum | A very thick wall is often better treated with surgery than with alcohol ablation. |
| Younger age | Younger patients tend to do very well with surgery and get the most durable, lasting benefit. |
| Another heart problem to fix at the same time | A leaky mitral valve or papillary-muscle problem can be repaired during the same open surgery. |
| Anatomy not suited to a catheter fix | If the heart artery that feeds the septum is not in the right spot, the catheter fix may not work well. Surgery is then a better choice. |
Treatment Options
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
- Septal myectomy (this surgery) — the surgeon removes a small wedge of thick septum to open the path out of the heart. Gold standard for severe obstruction.
- Alcohol septal ablation — a catheter procedure that injects a small amount of alcohol to shrink the thick muscle. No open surgery, but the pacemaker risk is higher. See our alcohol septal ablation guide.
- Mavacamten (Camzyos) — a newer medicine that targets the root cause of HCM and reduces the blockage. It may let some patients defer or avoid a procedure. See our mavacamten guide.
- Beta-blockers and calcium channel blockers — first-line medicines. They slow the heart and ease the blockage during activity. Tried before any procedure.
- Disopyramide — added for stubborn symptoms when other medicines are not enough.
- Mitral valve repair — sometimes done during the same surgery if the valve is leaking because of the blockage.
- Implantable defibrillator (ICD) — for patients at high risk of dangerous rhythms. This is separate from relieving the blockage.
- Heart Team review — a cardiologist and a heart surgeon experienced in HCM choose the best option with you. Ask to be sent to a high-volume HCM center.
Myectomy vs Alcohol Septal Ablation — at a glance
| Septal Myectomy | Alcohol Septal Ablation | |
|---|---|---|
| Approach | Open-heart surgery (sternotomy) | Catheter; alcohol into a small artery |
| Best for | Younger, very thick septum, or another fix needed | Older or higher surgery risk; right anatomy |
| Hospital stay | About 5 to 7 days | About 1 to 3 days |
| Recovery | About 6 to 8 weeks | About 2 to 3 weeks |
| Pacemaker risk | Lower (a few percent) | Higher (often 10 to 20%) |
| Durability | Excellent and long-lasting | Good; redo a bit more common |
Myectomy vs Alcohol Ablation: the Heart Team Choice
- Both relieve the blockage. Myectomy is open surgery; alcohol ablation is a catheter procedure that shrinks the muscle with a small amount of alcohol.
- Myectomy is usually preferred for younger patients, very thick septums, or when another heart problem (like a leaky valve) needs fixing at the same time.
- Alcohol ablation may be preferred for older patients, those at higher surgery risk, or when the heart-artery anatomy is right for it.
- A key difference is the pacemaker risk. It is lower after surgery and higher after alcohol ablation.
- The most important point: outcomes for either choice are far better at experienced, high-volume HCM centers. It is worth traveling for.
- Mavacamten (medicine) is a third path that may let some patients defer or avoid a procedure. Your Heart Team weighs all three with you.
Comfort Measures at Home (No Medication Needed)
These simple steps support healing and ease symptoms. Use them alongside any medication your doctor prescribes.
- Stay well hydrated. Being low on fluids can make the blockage worse.
- Avoid heavy weight lifting and straining, which can worsen the blockage. Ask your cardiologist what activity is safe for you.
- Limit alcohol, which can drop your blood pressure and worsen symptoms.
- After surgery, follow your sternal (breastbone) precautions: no pushing, pulling, or lifting more than about 10 pounds while the bone heals.
- Walk a little more each day as your team allows. Gentle, steady activity speeds recovery.
- Go to cardiac rehab if it is offered. It helps you rebuild strength safely after open-heart surgery.
Risks, Benefits, and Alternatives
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
Every choice has trade-offs. Use this table to start the shared decision conversation with your care team.
| Option | Risks | Benefits | Alternatives |
|---|---|---|---|
| Septal myectomy (this surgery) | Open-heart surgery. Small chance of needing a pacemaker, a rare hole in the septum, bleeding, stroke, or anesthesia problems. | Gold standard for severe blockage. Big, durable symptom relief. Very low risk at experienced centers. | Alcohol septal ablation; mavacamten; medicines only. |
| Alcohol septal ablation | Higher chance of needing a pacemaker than surgery. May not work as well if the artery anatomy is not ideal. | No open surgery. Shorter hospital stay and recovery. Good fit for selected patients. | Septal myectomy; mavacamten. |
| Mavacamten (medicine) | Frequent echo visits at first. Rare heart weakening if the dose is too high. Long-term medicine. | Works on the root cause. May let you put off or avoid a procedure. | Septal myectomy; alcohol ablation; other medicines. |
| Medicines only (no procedure) | May not be enough for severe symptoms. The blockage stays. | No procedure risk. Right first step for many patients. | Myectomy; alcohol ablation; mavacamten. |
Surgery, catheter, or medicine? For severe obstruction, myectomy is the gold standard, alcohol ablation is a catheter alternative, and mavacamten is a newer medicine that may let some patients defer surgery. A Heart Team helps you weigh them. See our alcohol ablation and mavacamten guides.
Common Misconceptions
| Myth | Reality |
|---|---|
| "Myectomy is too risky — it's open-heart surgery." | At experienced, high-volume HCM centers the risk of dying is well under 1%. Long-term survival can match the general population. |
| "Alcohol ablation is always easier, so it's always better." | Ablation avoids open surgery, but it carries a higher chance of needing a pacemaker. For younger patients and very thick septums, surgery is usually the better choice. |
| "The new medicine means no one needs surgery anymore." | Mavacamten helps many patients and may let some avoid a procedure. But surgery is still the gold standard for severe obstruction, and not everyone responds to medicine. |
| "Any heart surgeon can do this." | Myectomy is a specialized operation. Results are much better at centers that do many of them each year. It is worth traveling to an experienced HCM center. |
| "Once they remove the muscle, it grows back and I'll need it again." | Redo surgery is uncommon. At experienced centers the blockage usually stays relieved for many years. |
| "Surgery cures my HCM." | Myectomy relieves the blockage and its symptoms very well. But HCM is genetic and lifelong, so you still need follow-up and family screening. |
Possible Complications
Knowing what can go wrong helps you spot problems early. Most complications are uncommon, especially with treatment.
| Where / What | What Can Happen |
|---|---|
| Need for a pacemaker | The surgery can affect the heart's wiring. A small share of patients (lower than with alcohol ablation) need a pacemaker afterward. |
| Hole in the septum (VSD) | Rarely, removing muscle leaves a small hole between the chambers. It can be patched if it happens. |
| Leaky aortic valve | Rarely, the valve the surgeon works near can leak afterward and may need attention. |
| Bleeding | As with any open-heart surgery, bleeding can occur and sometimes needs a transfusion or a return to the operating room. |
| Stroke | A small risk with any heart surgery. The team takes steps to lower it. |
| Atrial fibrillation after surgery | A fast, irregular rhythm is common in the days after surgery. It is usually short-lived and easy to treat. |
| Anesthesia risks | General anesthesia carries its own small risks, which the anesthesia team manages. |
Recovery After Open-Heart Surgery
- You will be under general anesthesia. The surgery itself usually takes a few hours.
- You wake up in intensive care for a day or two, then move to a regular room. Most people go home in about 5 to 7 days.
- The breastbone (sternum) needs time to heal. For several weeks, avoid pushing, pulling, or lifting more than about 10 pounds.
- Full recovery to normal activities takes about 6 to 8 weeks. Your team will tell you when you can drive again.
- Cardiac rehab helps you rebuild strength safely. Walk a little more each day as allowed.
- Most patients feel a big, lasting improvement in breathing and energy. You will still need follow-up because HCM is lifelong.
Points to Know
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
If you remember nothing else, remember these key points.
- Septal myectomy removes a small piece of thick muscle to open the blocked path out of the heart.
- It is the gold standard for severe obstructive HCM, especially in younger patients and very thick septums.
- A Heart Team helps you choose between myectomy, alcohol ablation, and mavacamten.
- Where you have it matters: go to an experienced, high-volume HCM center.
- The pacemaker risk after surgery is lower than after alcohol ablation.
- Risks are like other open-heart surgery: bleeding, stroke, a rare septal hole, and anesthesia.
- Symptom relief is big and lasts for years at experienced centers.
- HCM is genetic. After your diagnosis, close relatives should be checked.
When to Call Us — and When to Call 911
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
If you are not sure, call. We would rather hear from you twice than miss a real problem.
- Call 911 for chest pain, severe shortness of breath, fainting, or signs of a stroke (face droop, arm weakness, slurred speech).
- Call 911 if your wound bleeds heavily or your breastbone feels like it is shifting or popping.
- Call our office if you have fever, redness, or drainage from your incision after surgery.
- Call our office if you feel a new fast or irregular heartbeat.
- Call our office if you faint or nearly faint at any time.
- Call our office if your shortness of breath comes back or gets worse.
- Call our office if you gain several pounds quickly or your legs swell.
- Call our office if a family member is newly diagnosed with HCM — you and your children may need screening.
Office: (727) 943-5200
Trusted Resources
Independent, evidence-based pages we recommend for deeper reading.
- Cleveland Clinic — Septal Myectomy — Patient overview of the surgery and recovery.
- Mayo Clinic — Septal Myectomy — Who is a candidate, the approach, and recovery.
- AHA — Hypertrophic Cardiomyopathy — How myectomy fits among HCM treatments.
- Hypertrophic Cardiomyopathy Association (4HCM) — Help finding an HCM center of excellence.
- Penn Medicine — Septal Myectomy — Plain-language procedure and recovery overview.
Sources Used to Build This Guide
- 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy [guideline] — Authoritative basis for septal myectomy as preferred septal reduction therapy in many patients, the gradient and symptom thresholds, experienced-center referral, and Heart Team decision-making.
- ACC — Ten Points to Remember: 2024 HCM Guideline [guideline] — Clinician summary of the 2024 HCM guideline, including septal reduction therapy indications and the comprehensive-center-of-excellence emphasis.
- Cleveland Clinic — Septal Myectomy [patient_education] — Patient-facing overview of open-heart surgery to remove thickened septal muscle in obstructive HCM, what to expect, and recovery.
- Mayo Clinic — Septal Myectomy [patient_education] — Describes the surgical approach, who is a candidate, recovery, and the excellent durability at high-volume HCM centers.
- Penn Medicine — Septal Myectomy [patient_education] — Plain-language description of the procedure, candidacy, and recovery course at an experienced center.
- American Heart Association — Hypertrophic Cardiomyopathy [patient_education] — Frames myectomy among HCM treatments and contrasts it with alcohol septal ablation for shared decision-making.
- JACC — Long-Term Effects of Surgical Septal Myectomy [research_article] — Landmark long-term follow-up showing durable symptom relief and survival after myectomy comparable to the general population at experienced centers.
- JACC — Mavacamten for Septal-Reduction-Eligible Patients (VALOR-HCM) [research_article] — VALOR-HCM trial: mavacamten markedly reduced the proportion of SRT-eligible patients still meeting criteria, supporting a medical-first option in selected cases.
- American Journal of Cardiology — Surgical Myectomy: Center Volume and Outcomes [research_article] — Multicenter analysis documenting the volume-outcome relationship and the case for referral to high-volume comprehensive HCM centers.
- Hypertrophic Cardiomyopathy Association (4HCM) [patient_education] — Patient community resource with guidance on finding HCM centers of excellence and surgical second opinions.
