The most common alternatives to septal myectomies are treatment with medication (usually
beta or
calcium blockers) or non-surgical thinning of tissue with
alcohol ablation. Ordinarily, septal myectomies are performed only after attempts at treatment with medication fail. The choice between septal myectomy and alcohol ablation is a complex medical decision.[citation needed]
Septal myectomy is associated with a low perioperative mortality and a high late survival rate. A study at the
Mayo Clinic found surgical myectomy performed to relieve outflow obstruction and severe symptoms in HCM was associated with long-term survival equivalent to that of the general population, and superior to obstructive HCM without operation. The results are shown below:[4]
Survival (all-cause mortality) *
Years
With surgery
Without surgery
1
98%
90%
5
96%
79%
10
83%
61%
Survival (HCM-related death)
Years
With surgery
Without surgery
1
99%
94%
5
98%
89%
10
95%
73%
Survival (sudden cardiac death)
Years
With surgery
Without surgery
1
100%
97%
5
99%
93%
10
99%
89%
* Includes 0.8% operative mortality.
Comparison with alcohol ablation
Either alcohol ablation or myectomy offers substantial clinical improvement for patients with
hypertrophic obstructive cardiomyopathy. One non-randomized comparison suggested that hemodynamic resolution of the obstruction and its sequelae are more complete with myectomy.[5] Whether one or the other treatment is preferable for certain patient types is debated among cardiovascular scientists.[6]