Hypertrophic cardiomyopathy is a heterogeneous disease with both medical and surgical treatment options. Patients with persistent symptoms after medical therapy with a left ventricular outflow tract (LVOT) gradient of >50 mm Hg are referred for septal myectomy. A review of both early and recent literature of outcomes of surgical therapy was performed. Specialized centers referred large numbers of patients for septal myectomy were the focus. Overall improvement in symptoms, morbidity, mortality, and long-term survival were re- viewed. Over the past 40 years, surgical therapy has shown consistent improvement in symptoms and reduction of LVOT gradient for pa- tients with hypertrophic cardiomyopathy. Furthermore, there has been a significant decrease in both morbidity and mortality for septal myectomy with improved techniques in the field of cardiac surgery and better understanding of the pathophysiology of the disease pro- cess. Surgical resection of the septum for hypertrophic cardiomyopathy is a safe, reproducible, and effective procedure for symptoma- tic patients with a significant LVOT obstruction.