When management with medication and implanted devices don’t fully control symptoms, surgery might be considered as an option.

Alcohol Septal Ablation 

In some patients with hypertrophic cardiomyopathy, thickening of the heart muscle can obstruct blood flow out of the heart. This can sometimes cause a change in symptoms and some people will be advised to have an alcohol septal ablation.

Alcohol Septal Ablation ( ASA) is a less invasive procedure than a surgical myectomy. During this procedure, alcohol is injected into a heart artery this causes the area of thickened heart muscle to reduce. This improves blood flow through the heart.

Septal Myectomy

Septal myectomy surgery is sometimes offered as a surgical procedure for some people with HCM with obstruction. This surgery will reduce the thickness of the septum. Your cardiologist should advise you which procedure would be the most appropriate for you.

Heart Transplant 

A small number of people may need to have a heart transplant. This involves removing the failing heart and replacing it with the heart from a donor. Assessment normally takes place in hospital over 2 of 3 days. 

Most patients accepted on to a transplant waiting list have an expected survival of 50 per cent or less over the following two years.  Survival after a heart transplant is 80 per cent, 70 per cent and 55 per cent at one, five, and ten years respectively.

Some patients improve significantly and may be able to come off the transplant list and continue on medication.

The surgery averages about four hours. The operation removes most of the heart, although a small cuff of the upper chambers may be left to attach the new heart onto.  After surgery, you can expect to be awake in a day and to spend a day or two in the intensive care unit.  

You will spend an average of three weeks in hospital and will be able to learn about your immunosuppressive drug combination, and how you can monitor yourself at home for complications.  You will receive physiotherapy, and be given advice on diet and lifestyle changes. Most people take several months to reach full fitness. During the first year you will need frequent hospital visits for tests including biopsies of your heart to look for evidence of rejection. The biopsy is an outpatient procedure (under local anaesthetic) and takes about half an hour. 

Depending on your occupation you may return to work three to six months after a heart transplant. Most people enjoy an excellent quality of life and rarely need admission to hospital other than for planned investigations. While a second transplant is possible, it is an option that is available to very few.

Read our statement on Organ Donation here