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Cardiothoracic surgery · UK

Septal myectomy - the definitive answer to obstructive HCM.

Open-heart surgery to remove thickened muscle from the ventricular septum in patients with obstructive hypertrophic cardiomyopathy. Performed at a small number of UK specialist units - the gold standard where alcohol septal ablation is not appropriate.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private Septal Myectomy (for Hypertrophic Cardiomyopathy) costs in the UK.

Ranges across UK cardiothoracic centres with HCM expertise. Volume matters - outcomes at high-volume units are markedly better than the national average.

In short

Private septal myectomy at a UK HCM centre: £45,000–£70,000, home in 6–8 nights.

Procedure Indicative range
HCM specialist consultation £300–£500
Cardiac MRI (HCM protocol) £800–£1,400
Cardiopulmonary exercise test £400–£700
Septal myectomy (isolated) £38,000–£55,000
Myectomy with mitral repair £45,000–£65,000
Myectomy with CABG or AVR £55,000–£85,000
ICD implantation (separate admission) £15,000–£25,000

Prices vary by hospital, by consultant, and by the complexity of your case.

The problem

HCM is often under-treated - myectomy fixes the obstruction, not just the symptoms.

HCM is common (about 1 in 500) and under-treated. Myectomy is the definitive answer for the obstructive form - but only at units with the volume to make it safe.

  • Volume changes outcomes

    HCM myectomy at a high-volume UK centre has an operative mortality under 1 percent. At a low-volume unit it is several times higher. We only work with proven teams.

  • Not everyone needs surgery

    Mavacamten and disopyramide have moved the goalposts. We discuss medical therapy honestly - surgery is for the patient it will help most.

  • The mitral valve tells half the story

    A good myectomy without addressing systolic anterior motion of the mitral valve is a half-done operation. We insist on surgeons who repair both.

When it helps

When Septal Myectomy (for Hypertrophic Cardiomyopathy) is the right step.

The situations that lead to septal myectomy, and the alternatives that sit alongside it.

  • Symptomatic obstructive HCM

    Breathlessness, chest pain, presyncope or syncope with LVOT gradient over 50 mmHg despite optimal medical therapy.

  • Younger patients

    Under 65 with good general health - myectomy usually preferred over alcohol septal ablation because it avoids the pacemaker risk and gives a durable result.

  • Anatomy unsuitable for ablation

    Very thick septum (over 30 mm), septal perforator anatomy that is not amenable, or mid-cavity obstruction - surgery is the only route.

  • Mitral valve involvement (SAM)

    Systolic anterior motion of the mitral valve driving obstruction and regurgitation - surgery addresses both in one sitting.

  • Concurrent cardiac surgery needed

    Coronary artery disease, aortic valve disease or ascending aortic disease - combining with myectomy avoids two operations.

  • Failed alcohol septal ablation

    Persistent obstruction after ablation is a myectomy indication - surgery clears what ablation could not.

  • Familial HCM with high-risk features

    Pathogenic variant, family history of sudden death, non-sustained VT - the ICD conversation runs alongside the surgical one.

  • Red flag: syncope on exertion

    Exertional syncope in HCM is an emergency assessment, not a routine outpatient wait. Same-week cardiology, not next-month.

Surgical variants

One operation, tailored to the mitral valve, the coronary tree and the shape of the septum.

  • Classical (Morrow) myectomy

    The original operation described in 1960. Basal septal muscle resected through the aortic valve. Refined and extended by modern HCM units.

  • Extended septal myectomy

    Modern standard. Resection extends further apically and laterally, addressing mid-cavity obstruction as well as the basal septum.

  • Myectomy with mitral valve repair

    Mitral leaflet plication or edge-to-edge repair addresses systolic anterior motion - often combined with anterior leaflet extension.

  • Trans-apical myectomy

    For mid-ventricular or apical HCM where a trans-aortic approach cannot reach. Reserved for specific anatomy at very few UK centres.

  • Alcohol septal ablation (alternative)

    Catheter-based alternative in older or higher-risk patients. Ethanol injected into a septal perforator artery causes controlled infarction. Higher pacemaker rate; may be preferred for anatomy.

  • Mavacamten (medical alternative)

    A cardiac myosin inhibitor for obstructive HCM - reduces gradient and symptoms. Some patients avoid surgery on mavacamten; others still need it.

  • ICD implantation

    For high-risk patients - often placed at the same admission or shortly after myectomy where indicated.

  • Combined with CABG or AVR

    Where coronary disease or aortic stenosis coexists, myectomy is done at the same operation.

Safety and recovery

What to expect afterwards - honestly.

Septal myectomy at a proven UK HCM centre is a very safe operation. Risk climbs at low-volume units - the honest reason we work with only a handful of teams.

  • General anaesthetic and cardiopulmonary bypass

    Full sternotomy under a cardiac anaesthetist. Bypass time typically 60–90 minutes; total theatre time 3–5 hours.

  • Operative mortality at high-volume units

    Under 1 percent at proven HCM centres. Elsewhere it can be several times higher - the reason we insist on volume.

  • Iatrogenic ventricular septal defect

    Rare (under 2 percent) when done by high-volume surgeons - repaired at the time. Slightly more common in very thick septa.

  • Complete heart block and pacemaker

    Under 5 percent after myectomy at experienced units. Higher after alcohol septal ablation (10–20 percent) - one of the reasons younger patients often prefer surgery.

  • Aortic valve injury

    A recognised risk of trans-aortic exposure. Repaired or replaced during the same operation if it occurs - very uncommon in experienced hands.

  • Bleeding, transfusion and stroke

    Bleeding requiring return to theatre under 3 percent. Stroke under 1 percent. Standard risks of any open-heart operation, minimised by team experience.

  • Atrial fibrillation, wound infection

    Post-operative AF 20–30 percent - usually short-lived, sometimes needs cardioversion. Sternal wound infection under 2 percent.

  • HCM does not go away

    Myectomy relieves obstruction - it does not cure HCM. Genetic risk, arrhythmia risk and screening for relatives continue for life.

  • Red flags after discharge

    Chest pain, breathlessness at rest, palpitations with dizziness, wound discharge or fever - call the surgical team the same day.

Reading your report

Your operation note in four parts. Read the last one first.

Whether the operation was an extended myectomy alone or combined with mitral repair, the note the surgeon sends you keeps to the same shape.

A UK consultant reviewing notes with a patient - Septal Myectomy (for Hypertrophic Cardiomyopathy)

A quiet reminder

Medical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the report before your review, just ask.

  1. 01 Header

    Indication and preoperative gradient

    Why the operation was done, the pre-op LVOT gradient at rest and with provocation, and any concurrent disease being addressed.

  2. 02 Technique

    Extent of resection and mitral repair

    How much muscle was resected, where from, and what was done to the mitral valve. Weight of septal tissue removed is often quoted.

  3. 03 Findings

    Post-bypass echocardiography

    The intraoperative TOE numbers - residual gradient, mitral regurgitation, LV function. This is the objective proof the operation worked.

  4. 04 Plan

    Rehab, medication and surveillance

    Read this first: the cardiac rehab schedule, beta-blocker plan, anticoagulation if needed, and the timing of follow-up echos.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Septal myectomy for symptomatic obstructive HCM is generally covered by UK insurers under cardiac surgery benefits.

Frequently asked

Everything we get asked about Septal Myectomy (for Hypertrophic Cardiomyopathy).

Quick answers on eligibility, alternatives, mavacamten, ICDs and long-term outlook.

  • Who is the right patient for septal myectomy rather than alcohol septal ablation?

    In UK and international guidelines, myectomy is generally preferred for younger patients (under 65), those with very thick septa, mitral valve pathology contributing to obstruction, coexisting coronary or valvular disease, or where septal perforator anatomy is unsuitable for ablation. Ablation is a reasonable alternative in older or higher-risk patients with favourable anatomy.

  • How does mavacamten fit in?

    Mavacamten is a cardiac myosin inhibitor that reduces LVOT gradient and symptoms in obstructive HCM. In the EXPLORER-HCM and VALOR-HCM trials it reduced the proportion of patients meeting criteria for septal reduction therapy at 16 weeks. For some patients it delays or avoids surgery; for others surgery is still the right answer. We put both on the table.

  • What are the long-term results?

    At experienced UK and international centres, septal myectomy has a 30-day mortality under 1 percent, near-complete relief of the LVOT gradient in over 90 percent, and long-term survival that approaches that of the general population. Symptomatic improvement is durable at 10 and 20 years in most patients.

  • Will I need an ICD?

    Not automatically. ICD indication is driven by the HCM sudden-death risk score - family history of sudden death, non-sustained VT, unexplained syncope, extreme wall thickness, apical aneurysm, or a pathogenic sarcomere variant. Where indicated, the ICD is placed at the same admission or shortly after myectomy.

  • How much does private septal myectomy cost in the UK?

    Roughly £45,000–£70,000 all-in at a high-volume UK centre, including workup, surgery, ICU stay, ward care and cardiac rehab. Concurrent CABG or aortic valve surgery adds £10,000–£25,000. Insurers usually cover septal myectomy for symptomatic obstructive HCM.

  • Do my family members need testing?

    Yes. HCM is autosomal dominant. First-degree relatives are offered clinical screening (ECG and echocardiography) and, where a pathogenic variant has been identified, cascade genetic testing. Screening intervals depend on age and clinical status.

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