Surgery for hypertrophic obstructive cardiomyopathy: the European perspective

Europe has played a foundational role in understanding hypertrophic cardiomyopathy (HCM), yet surgical treatment-particularly septal myectomy-has seen uneven adoption across the continent. Widespread reliance on alcohol septal ablation (ASA) and the more recent introduction of cardiac myosin inhibitors (CMIs) have contributed to a decline in surgical expertise. This perspective reviews the historical evolution of HCM surgery in Europe and the impact of contemporary figures and centers. Drawing on direct correspondence with active European surgeons and institutional data, the manuscript outlines the status of myectomy programs, revealing wide disparities in access, volume, and national coordination. With the data attained here, only three European centers perform more than 25 septal myectomies per year. It also evaluates the clinical and economic implications of surgical versus pharmacological approaches. Emphasis is placed on the urgent need for structured training, procedural standardization, and broader recognition of myectomy as a definitive and cost-effective treatment for obstructive HCM.