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(Circulation. 2007;116:196-206.)
© 2007 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Is septal ablation preferable to surgical myomectomy for obstructive hypertrophic cardiomyopathy?

Surgical Myectomy Remains the Primary Treatment Option for Severely Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy

Barry J. Maron, MD

From the Minneapolis Heart Institute Foundation, Minneapolis, Minn.

Correspondence to Barry J. Maron, MD, Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 60, Minneapolis, MN 55407. E-mail hcm.maron@mhif.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The evolving alcohol septal ablation versus surgical myectomy controversy represents a crossroad in the management of obstructive hypertrophic cardiomyopathy (HCM). Indeed, in this now polarized debate within the cardiovascular community, between the traditional and established (ie, surgery) and the new and percutaneous (ie, ablation), much is at stake for the HCM patient population. Furthermore, this issue has become increasingly important given the visibility recently afforded the pathophysiological significance and frequency of left ventricular (LV) outflow gradients in this disease.^1,2

Response by Fifer p 206

In the course of this discussion, I will vigorously defend surgery as the primary treatment of choice when outflow obstruction (gradient 50 mm Hg at rest or with physiological exercise) produces heart failure symptoms refractory to maximal medical management (New York Heart Association functional classes III and IV).^3,4 To this purpose, I will rely on the 50-year experience and substantial body of evidence available in HCM, as well as my own personal extensive association with and work in this disease spanning >30 years and several hundred publications—neither as a surgeon or interventional cardiologist nor with any particular allegiance to either discipline. The message expressed herein is prosurgery, but it is by no means antiablation, for this treatment modality has proved useful (although with a selective role) in the management of HCM.

	Surgical Septal Myectomy

 
Historical Context
When surgical septal myectomy (Table 1) was initially introduced in the early 1960s at several North American and European centers, it was regarded as revolutionary and has subsequently stood the test of time. . . . [Full Text of this Article]

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