The traditional myectomy, also known as the Marrow Procedure, has been enhanced over the years. The original thought of creating a "trough" has been expanded to a wider and deeper resectioning of the heart. There are now a few surgeons in the United States preforming an Apical Myectomy, with different approaches.
At the Cleveland Clinic, they use a traditional approach via the aorta and resection down deeply to the apex of the heart. At the Mayo Clinic they use an Apical approach, normally along with a traditional aortic approach. The apical approach is newer and there is only a single center preforming it in this manner. For those with Apical HCM in need of surgical care, it is advised you seek input from those skilled in this unique procedure.
Below is a link to the Mayo Clinics approach to apical myectomy.