Objective of the study: to evaluate whether alfieri technique improves clinical and hemodynamic results compared to transaortic mitral valve secondary cord cutting in patients scheduled to septal myectomy for severely symptomatic hypertrophic obstructive cardiomyopathy.

There is pilot prospective randomised study comparing immediate and early results of additional subvalvular mitral apparatus intervention versus additional alfieri stich in patients scheduled to septal myectomy for symptomatic obstructive cardiomyopathy.

Patients with proven hypertrophic cardiomyopathy and resting left ventricle outflow tract obstruction underwent septal myectomy. If patients were suitable for both surgical techniques, they were randomized to alfieri stich or secondary cord cutting. All surgeons were experienced at least 50 related procedures.

Inclusion Criteria:

• Hypertrophic obstructive cardiomyopathy
• Left ventricle outflow tract gradient > 50 mm Hg at rest
• Systolic anterior motion mediated mitral regurgitation

Exclusion Criteria:

• Intrinsic valvular heart disease
• Coronary artery disease
• Aortic disease

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