Septal myectomy remains the gold standard

This editorial refers to ‘A contemporary European experience with surgical septal myectomy in hypertrophic cardiomyopathy’, by A. Iacovoni et al. , doi:10.1093/eurheartj/ehs064 Improvements in the understanding of the haemodynamic abnormalities and pathophysiology of obstructive hypertrophic cardiomyopathy (HCM), as well as advances in surgical techniques have resulted in septal myectomy being the preferred treatment option for severe symptoms refractory to medical therapy.1 The recent American College of Cardiology (ACC)/American Heart Association (AHA) guidelines emphasized the importance of focused expertise in the diagnosis, and medical and surgical management of HCM.1 Consequently, there are a growing number of centres dedicated to HCM in the USA.The study of Iacovoni et al. 2 has important implications for the management of obstructive HCM in Europe. After the introduction of alcohol septal ablation (ASA) ∼15–20 years ago, septal myectomy has essentially disappeared in Europe. In fact, a recent review article on the management of obstructive HCM by a European institution did not even acknowledge septal myectomy as a treatment option in the management of patients with heart failure symptoms related to outflow obstruction.3 This has resulted in the vast majority of patients with symptomatic HCM in Europe being treated with ASA, and in the process denied the option of septal myectomy.Surgical techniques for relief of left ventricular outflow …