Will I Need Surgery to Treat My Hypertrophic Cardiomyopathy?

After receiving a diagnosis of hypertrophic cardiomyopathy (HCM), your doctor will likely recommend one or more medications. Medications are often the first line of treatment for this genetic heart disease. They may help reduce symptoms and the risk of cardiac arrest.

However, not everyone finds relief from medications alone. If you’re still having symptoms, or HCM is continuing to affect your quality of life, you may be a candidate for surgery.

What surgeries are available for hypertrophic cardiomyopathy?

Two procedures that may help treat HCM include:

• Surgical myectomy

• Alcohol septal ablation

What is a surgical myectomy for hypertrophic cardiomyopathy?

A surgical myectomy is typically an open heart surgery. Once inside the heart, the surgeon will shave off the thickened part of the heart tissue. This will instantly reduce the blockage caused by HCM. Research shows that surgical myectomy tends to:

• Restore blood flow

• Reduce the risk of cardiac arrest

• Reduce episodes of fainting

• Improve survival

Because it’s an open heart surgery, recovery time for a surgical myectomy is generally longer than for an alcohol septal ablation.

Who benefits from a surgical myectomy?

A surgical myectomy may be beneficial if:

• You have other heart abnormalities that need attention

• You have significant heart wall thickening that is causing obstruction

During the open heart surgery, your surgeon is able to perform additional procedures to help your heart health if needed. For example, your surgeon may perform surgery on your coronary arteries or the heart valves.

What is an alcohol septal ablation for hypertrophic cardiomyopathy?

Alcohol septal ablation is a nonsurgical procedure. The doctor uses a catheter (small tube) with a small balloon on the end. They will place this tube into a blood vessel in your groin until it reaches the affected area of the heart. 

Then, the doctor will inject a tiny amount of alcohol. This will reach the cells of the heart where the tissue is hypertrophic (thickened). The toxicity of the alcohol will cause those heart cells to shrink and eventually die. This thins the obstruction and improves blood flow.

Who benefits from alcohol septal ablation?

For some people, open heart surgery may be too risky. Older adults and people with other underlying conditions may benefit from alcohol septal ablation instead of surgical myectomy. Alcohol septal ablation may also be a better option if your thickened tissue is less severe.

Some people may be eligible for either type of procedure. In this case, they may choose which procedure for hypertrophic cardiomyopathy is right for them based on their personal preferences, or by weighing the risks and benefits.

“Both of these are effective treatments, and your cardiologist can help determine which of these would be best for you,” says Sirish Vullaganti, MD, Cardiologist at Northwell Health. 

“We are constantly getting new medical therapies, new procedures, new diagnostic testing that have been shown to help with this condition,” says Dr. Vullaganti.