Our understanding of hypertrophic cardiomyopathy (HCM) as a disease entity has increased dramatically over the last half century. There has been a concerted effort by several surgical groups to develop operative techniques to relieve left ventricular outflow tract (LVOT) obstruction and alleviate symptoms. This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. In addition, we introduce newer methods for myectomy that have expanded the role of surgery in patients with various forms of HCM.