Periprocedural Complications and Long-Term Outcome After Alcohol Septal Ablation Versus Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy: A Single-Center Experience

Study Questions:

What is the procedural and long-term safety of alcohol septal ablation (ASA) and surgical myectomy in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM)?

Methods:

The authors compared all ASA (n = 161) and myectomy (n = 102) procedures performed between 1981 and 2010 at their center for periprocedural complications and long-term clinical outcome. The primary endpoint was all-cause mortality, and secondary endpoints consisted of cardiac mortality, New York Heart Association functional class, rehospitalization for heart failure, reintervention, cerebrovascular accident, and myocardial infarction.

Results:

ASA was associated with a lower 30-day complication rate compared with myectomy (14% vs. 27%, p = 0.006). Length of hospitalization was shorter after ASA (5 days vs. 9 days, p < 0.001). Provoked gradients were higher after ASA (19 mm Hg vs. 10 mm Hg). There was no difference in long-term survival, and annual cardiac mortality after ASA and myectomy were comparable (0.7% vs. 1.4%, p = 0.15). During follow-up, no significant differences were found in symptomatic status, rehospitalization for heart failure, reintervention, cerebrovascular accident, or myocardial infarction between both groups.

Conclusions:

The authors concluded that there was no difference in the long-term outcome of patients undergoing ASA or surgical myectomy.

Perspective:

Current guidelines recommend myectomy as the primary choice for septal reduction, in part over concerns about increased long-term mortality after ASA. Many studies (including the current one) have demonstrated similar outcomes among patients treated with either procedure at experienced centers, although an adequately powered randomized trial has not been performed. Currently, there are no strong data to support superiority of one procedure over the other. Patients with symptomatic HOCM should be treated at centers with experience in both procedures, and the choice of the procedure should be dictated by patient and physician choice based on the patient’s unique clinical profile.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Myocardial Infarction, Stroke, Alcohols, Follow-Up Studies, Cardiomyopathy, Hypertrophic, Heart Failure, Hospitalization


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