Hypertrophic Cardiomyopathy (HCM) Surgery: Know Your Options
Cardiovascular DiseasesHeart Disease

Hypertrophic Cardiomyopathy (HCM) Surgery and Procedure Options: What to Know About Septal Myectomy, Septal Ablation, and Heart Transplant

Hypertrophic Cardiomyopathy (HCM) Surgery and Procedure Options: What to Know About Septal Myectomy, Septal Ablation, and Heart Transplant
Everyday Health
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Updated on February 5, 2026
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When medications aren’t doing enough to manage your hypertrophic cardiomyopathy (HCM), surgical procedures can offer real relief.

HCM is a genetic heart condition in which parts of the heart muscle become abnormally thick, making it harder for the heart to pump blood as it should. In obstructive HCM, the thickening limits or blocks blood flow from the heart to the rest of the body, causing symptoms like chest pain, shortness of breath, fatigue, dizziness, and fainting.

“Surgery is considered for patients with severe, persistent symptoms from obstructive hypertrophic cardiomyopathy despite maximally tolerated therapy,” says Mohammed Makkiya, MD, the director of VCU Health Pauley Heart Center’s HCM clinic in Richmond, Virginia. The decision to have surgery should be made with input from your cardiology and surgery team, considering the most common procedures, how they work, and their benefits and drawbacks.

Septal Myectomy

Septal myectomy is an open heart surgery during which a portion of thickened heart muscle that’s blocking blood from flowing out of the heart is removed.

“It’s the gold standard for many patients,” says Dr. Makkiya.

During septal myectomy, you’re placed under general anesthesia and connected to a cardiopulmonary bypass machine to take over the work of your heart and lungs. Your surgeon makes a large incision down the center of your chest and uses a blade to remove the thickened portion of tissue from your heart. You’re then disconnected from the cardiopulmonary bypass machine and your surgeon closes your incision with absorbable stitches.

The procedure typically takes three to four hours, followed by about five days of recovery in the hospital.

 Most people fully recover within six to eight weeks.

Why Septal Myectomy Works

Reducing or eliminating a blockage makes it easier for your heart to send blood to the rest of your body. As a result, almost all patients experience a major difference in symptoms like shortness of breath, chest pain, fainting, or lightheadedness.

“Patients usually feel significantly better almost immediately,” says Sandeep Jani, MD, MPH, the associate director of advanced heart failure and population health at MedStar Heart and Vascular Institute in Baltimore.

There are long-term benefits, too. Studies show that obstructive HCM patients who undergo septal myectomy have higher long-term survival rates than those who don’t have surgery.

Septal myectomy is generally considered a safe procedure. But as with all open-heart surgeries, it comes with some risks, including fluid buildup around the heart or lungs, atrial fibrillation, or disruptions to the heart’s electrical system.

 Ideally, you can have this procedure at a facility that is extremely familiar with it. Undergoing surgery at a hospital that performs more than 10 myectomies per year is tied to lower rates of complications, research shows.

Who Is Septal Myectomy For?

Septal myectomy can be an option if medications alone aren’t doing enough to manage your obstructive HCM. In general, it’s more likely to be recommended for younger patients who are at low risk of complications from open-heart surgery, says Dr. Jani.

The decision to undergo septal myectomy is highly individualized. Talk with the members of your cardiology care team, including your cardiologist, imaging specialist, and surgeon, to weigh the benefits and risks and make the best choice for you.

Septal Ablation

Septal ablation is a minimally invasive alternative to septal myectomy. The procedure involves injecting alcohol through a catheter (a thin, flexible tube) to a targeted area of thickened heart muscle in an effort to shrink it.

During septal ablation, you’re given medication to help you relax. You may also receive blood-thinning medications to reduce the risk of a blood clot. Your care team will also apply a local numbing agent around the wrist or groin area where the catheter will be inserted.

Your doctor will then insert the catheter into an artery or vein in your wrist or groin and thread the catheter up to your heart. Once the catheter has reached your heart, a small amount of alcohol will be injected into the catheter, where it will travel to your thickened heart muscle. This can cause some mild discomfort or pressure. Then your doctor will remove the catheter and bandage the area of your wrist or groin where the catheter was placed.

Septal ablation typically takes one to two hours and is performed while you’re awake. Most people recover in the hospital for a few days after the procedure and can return to their normal activities in about a week.

Why Septal Ablation Works

Injecting alcohol into the thickened part of the heart muscle causes it to thin without negatively affecting healthy heart tissue, resulting in improved blood flow from your heart to the rest of your body.

Most patients notice a dramatic improvement in symptoms like chest pain and shortness of breath, and their ability to exercise or be active.

 The effects aren’t immediate, though. It often takes a few weeks for the alcohol to fully thin the thickened heart tissue, says Jani. “Some people will also need more than one ablation” to reap the full benefits of the procedure, he says.
Septal ablation, while generally considered safe, can increase one’s risk of heart rhythm problems. People who have the procedure are nearly twice as likely to need a pacemaker as those who undergo septal myectomy.

Who Is Septal Ablation For?

Septal ablation is a second-line intervention option for obstructive HCM that is generally offered to people for whom a septal myectomy is inappropriate.

“The choice depends on anatomy, age, comorbidities, and patient preferences, as well as center expertise,” says Makkiya.

Older adults, those with additional health issues, and those who may not be able to withstand an open-heart surgery like septal myectomy are more likely to undergo septal ablation. It can also be an option for people whose heart thickening is less severe.

Heart Transplant

A heart transplant is major surgery that replaces your heart with a donor heart. It’s a last-resort option for people with HCM who haven’t responded to other treatments and are experiencing end-stage heart failure.

 It’s also relatively rare: Only about 3.5 percent of HCM patients undergo heart transplant.

During a heart transplant, you’re put under general anesthesia and connected to a ventilator and a cardiopulmonary bypass machine. Your surgeon makes a large incision in your chest to remove your heart, which involves disconnecting your heart from surrounding blood vessels. Then the new heart is implanted and connected to those same blood vessels. From there, your incision is closed, and you’re moved to a recovery room in the intensive care unit.

Heart transplantation is a long process. “It requires a lot of testing and a large committee of healthcare practitioners to understand the risks and benefits in a given patient,” says Jani. From there, you’re added to a transplantation waiting list, with wait times varying significantly depending on how urgently you need a heart and when hearts become available.

Once a donor heart is available, the surgery to receive your new heart takes about six hours. After surgery, you recover in the hospital for 7 to 10 days.

 It takes 6 to 8 weeks for the incision to heal, and full recovery can take many months.

Why Heart Transplants Work

Unlike your old heart, your donor heart won’t have blockages caused by HCM. As a result, you’ll live a longer, healthier life than you would have without transplantation. Survival rates for HCM patients after a heart transplant are about the same as survival rates for patients who have heart transplants for other reasons, with around 75 percent of transplant recipients living for more than five years.

But you will still need lifelong follow-ups with your cardiology team to monitor your new heart. You will also need to take immunosuppressants to reduce the risk of your body rejecting your new heart, as well as take steps to reduce your risk of infections.

Who Is a Heart Transplant For?

Heart transplants are typically reserved for people whose HCM has led to end-stage heart failure. You also generally need to meet certain criteria to be a good candidate for a donor heart. For instance, transplants aren’t often performed in adults over 70. You will also need to avoid alcohol, tobacco, and drugs, and undergo a long list of tests to make sure your body is healthy enough to withstand a transplant.

Other Surgeries

In certain instances, your care team may recommend a different surgery or procedure for your HCM. Some options may include:

  • Catheter ablation for arrhythmias
  • Coronary artery bypass grafting (CABG)
  • Heart valve repair or replacement
  • Maze procedure (typically a treatment for atrial fibrillation)
  • Pulmonary vein ablation

These additional procedures may be necessary to treat the secondary complications or independent conditions that often accompany HCM, such as heart rhythm disorders, severely damaged valves, or restricted blood flow to the heart muscle itself.

Implantable Cardioverter-Defibrillators (ICDs)

Many people with HCM are treated with an implantable cardioverter-defibrillator (ICD). These small, battery-powered devices don’t reduce symptoms, but they are the most effective way to reduce one’s risk of sudden cardiac death with HCM.

 They work by monitoring a person’s heart rhythm and resetting it if a person goes into sudden cardiac arrest.

The Takeaway

  • Considered the "gold standard," septal myectomy is an open-heart surgery that involves physically removing thickened heart muscle to immediately improve blood flow and long-term survival.
  • Septal ablation is a minimally invasive alternative, typically for older patients or those with other health issues, that uses alcohol injections via a catheter to shrink the thickened heart tissue.
  • Heart transplantation is a rare, "last-resort" procedure reserved for patients with end-stage heart failure who have not responded to other treatments.
  • Additional interventions include ICDs, the most effective tools for preventing sudden cardiac death, as well as specialized procedures to treat related issues like arrhythmias and valve damage.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  5. Ommen S et al. Long-Term Effects of Surgical Septal Myectomy on Survival in Patients With Obstructive Hypertrophic Cardiomyopathy. Journal of the American College of Cardiology. August 2005.
  6. Alcohol Septal Ablation. Johns Hopkins Medicine.
  7. Alcohol Septal Ablation. Cleveland Clinic. February 23, 2022.
  8. Bali A et al. Treatment Strategies for Hypertrophic Cardiomyopathy: Alcohol Septal Ablation and Procedural Step-by-Step Technique. The American Journal of Cardiology. February 1, 2024.
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  13. Frequently Asked Questions About Heart Transplantation. Johns Hopkins Medicine.
  14. Post Transplant Process and Recovery. Cleveland Clinic.
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Cheng-Han Chen

Cheng-Han Chen, MD, PhD, FACC, FSCAI

Medical Reviewer

Cheng-Han Chen, MD, PhD, is the medical director of the structural heart program at MemorialCare Saddleback Medical Center in Laguna Hills, California, and director of structural and interventional cardiology at Pacific Cardiovascular Associates Medical Group.

Dr. Chen completed his bachelor’s and master’s degrees at MIT in materials science and engineering. He received his MD degree from UCSD and his PhD in bioengineering from UCLA.

As a medical device engineer at Medtronic, Chen played an important role in the development of the Endeavor and Resolute drug-eluting coronary stents. His internship and residency were completed at UCLA, where he also completed his cardiovascular disease fellowship. He went on to complete both interventional cardiology fellowship followed by structural heart disease fellowship at NewYork-Presbyterian/Columbia University Hospital. While at Columbia, he was closely involved in the major clinical trials involving transcatheter aortic valve replacement (TAVR).

Chen has presented his research at major national and international conferences including the American Heart Association (AHA), American College of Cardiology (ACC), and Transcatheter Cardiovascular Therapeutics (TCT), and has authored multiple manuscripts and book chapters on subjects ranging from interventional cardiology to cardiac stem cells. Prior to his current roles, he served on faculty of Columbia University Medical Center as a clinical instructor.

Outside of the office, Chen enjoys spending time with his wife and children. He is also an accomplished violinist.

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Marygrace Taylor

Marygrace Taylor

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Marygrace Taylor is an award-winning freelance health and wellness writer with more than 15 years of experience covering topics including women’s health, nutrition, chronic conditions, and preventive medicine. Her work has appeared in top national outlets like Prevention, Parade, Women’s Health, and O, The Oprah Magazine.

She's also the coauthor of three books: Eat Clean, Stay Lean: The Diet, Prevention Mediterranean Table, and Allergy-Friendly Food for Families. She lives in Philadelphia.

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