Obstructive hypertrophic cardiomyopathy (HCM) can be treated by transaortic subaortic myectomy, which has been shown to improve patients' symptoms and abolish left ventricular outflow tract obstruction. Different options, such as dual chamber pacing and septal ethanol ablation, are now available for the management of obstructive HCM, and it is important to evaluate the risks and benefits of myectomy, especially its impact on survival. In this article, the authors review the clinical course of obstructive HCM and the early and long-term results of surgery. They examine the outcomes of obstructive HCM in patients after surgical versus conservative therapy. In addition, they review the studies that have compared other techniques to surgery for the management of obstructive HCM.