For patients with symptomatic hypertrophic obstructive cardiomyopathy, the available surgical treatment options are the emerging septal alcohol ablation (ASA) and the traditional hypertrophic septal myotomy. The latter procedure is more established and more commonly used, however, it is still controversial whether ASA is as safe and effective as conventional hypertrophic septal myotomy. For this reason, Dr. Robbert and colleagues from the Martigny Hospital in the Netherlands conducted a study with the aim of comparing the incidence of perioperative complications and the long-term clinical prognosis of ASA versus myotomy. The article was published in the journal JACC in November 2014. The study reviewed cases from 1981 to 2010, with all-cause death as the primary endpoint and cardiac death per year, New York Heart Association functional class, readmission for heart failure, reintervention, cerebrovascular events and myocardial infarction as secondary endpoints. A final total of 161 patients after ASA and 102 patients after myomectomy were included, with a maximum follow-up of 11 years. The results found that patients in the ASA group had a lower incidence of complications within 30 days after surgery and a shorter hospital stay compared with the myomectomy group (5 days: 9 days). Multivariate variables (including long-term survival, risk of complications, and clinical prognosis) did not differ between the two groups, and the difference in the annual incidence of cardiac death was not significant (0.7%:1.4%). However, patients in the ASA group had a higher excitation pressure difference than those in the myotomy group (median 19:13). In conclusion, multiple variables (including long-term survival, risk of complications, and clinical prognosis) were comparable for ASA compared with myotomy. However, some patients with symptomatic obstructive cardiomyopathy may require myotomy in specific circumstances (e.g., other underlying disease of their own and the individual patient’s wishes).