The left ventricular outflow tract – How surgery for hypertrophic cardiomyopathy is changing?

The gold standard in the treatment of hypertrophic obstructive cardiomyopathy is transaortic surgical myectomy, a technique with a proven 60-year track record, which eliminates obstruction and improves symptoms and, therefore, functional capacity and with established cost-effectiveness. Newer pharmacological agents such as myosin inhibitors are now being tested in clinical practice. A surgical alternative has recently been introduced, transapical beating-heart septal myectomy. This approach has the same goals as transaortic myectomy and offers additional advantages such as its minimally invasive nature, as no cardiopulmonary bypass and cardiac arrest are needed, together with a real-time assessment of resection with intraoperative transoesophageal echocardiography. Patients with an appropriate indication for septal myectomy will benefit from this newly introduced procedure.