Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: A 16-Year Australian Single Centre Experience

Nogic, Jason; Koh, Youlin; Bąk, Marek; Gooley, Robert; Meredith, Ian T.; McCormick, Liam

doi:10.1016/j.hlc.2017.09.014

Cited by 11 publications

(6 citation statements)

References 37 publications

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“…Indeed, at both early and late follow-up, resting LVOT gradients were on average lower after myectomy compared with ASA (Table 2). This finding is similar to data from Nogic and colleagues, 24 who reported persistent postprocedure gradients of more than 20-50 mm Hg, suggesting that ASA may not adequately relieve LVOT obstruction in some patients. In our surgical patients, postintervention gradient was independent of severity of preoperative LVOT obstruction, but with ASA, early follow-up gradient was strongly related to preprocedure gradient (Figure 3).…”

Section: Relief Of Left Ventricular Outflow Tract Gradientsupporting

confidence: 89%

Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: A propensity score–matched cohort

Nguyen

Schaff

Hang

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

100

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Objectives: In patients with hypertrophic cardiomyopathy, obstruction of the left ventricular outflow tract can be relieved by surgical septal myectomy or alcohol septal ablation, but uncertainty remains regarding long-term results and comparative effectiveness of alcohol septal ablation. This study aims to compare shortand long-term outcomes of the 2 procedures.Methods: Between December 1998 and September 2016, 2407 patients underwent septal myectomy and 211 patients underwent alcohol septal ablation at our institution. After 2:1 propensity score matching, the study cohort included 334 patients who underwent myectomy and 167 patients who underwent alcohol septal ablation.Results: Median (interquartile range) ages of patients in the myectomy and alcohol septal ablation groups were 65 (58-71) years and 64 (56-73) years (P ¼ .9), respectively. After intervention, median resting left ventricular outflow tract gradient at predischarge transthoracic echocardiography was 0 (0-10) mm Hg in the myectomy group (n ¼ 288) and 21 (10-60) mm Hg in the alcohol septal ablation group (n ¼ 63) (P <.001, tested at baseline gradients of 30 and 50 mm Hg). There were no differences in survival between the 2 groups (risk of death for alcohol septal ablation vs myectomy, hazard ratio, 1.5; 95% confidence interval, 0.9-2.6; P ¼ .1). Survival of patients undergoing septal myectomy was better than that of an age-, sex-, and race-matched US population (82% vs 75% at 12 years, P ¼ .01). Reintervention for left ventricular outflow tract obstruction was more likely to occur in patients who received alcohol septal ablation (hazard ratio, 33.3; 95% confidence interval, 4.4-250.6; P <.001).Conclusions: There were no differences in survival of patients undergoing myectomy or alcohol septal ablation, but freedom from reintervention and early and late reduction of left ventricular outflow tract gradient are superior in patients undergoing septal myectomy.

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Section: Relief Of Left Ventricular Outflow Tract Gradientsupporting

confidence: 89%

Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: A propensity score–matched cohort

Nguyen

Schaff

Hang

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

100

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“…Our study involved 20 patients who had undergone ASA at Nasiriya Heart Centre over six years. The rate of ASA procedure in our center (3.33/year) was comparable to that in previous similar studies (59)(60)(61).…”

Section: Discussionsupporting

confidence: 88%

“…HCM is a common genetic cardiac disease (11). Most of the available data about outcomes of ASA procedures were from either single centers or registries in the form of retrospective, non-randomized studies (58)(59)(60)(61)(62)(63)(64).…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Complications of alcohol septal ablation for younger patients with hypertrophic obstructive cardiomyopathy: a single-centre study

Assim¹,

Al-Kinani²,

AL-Obaidi³

2021

Interv Akut Kardiol

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Backgrounds: Hypertrophic cardiomyopathy (HCM) is a genetic disorder of cardiac muscle with a heterogeneous clinical course. Alcohol septal ablation is a treatment option for severely symptomatic drug-refractory hypertrophic obstructive cardiomyopathy. This study aimed to determine the outcome of alcohol septal ablation in 20 patients from a single center in Iraq. Methods: Twenty patients with age less than 60 years had undergone alcohol septal ablation between May 2013 and February 2019 at Nasiriya Heart Centre. Patients were selected for alcohol septal ablation depending on the clinical and angiographic suitability of septal perforator branches. Clinical, electrocardiographic, and echocardiographic parameters were evaluated in the periprocedural period and during follow-up. Results: Only three patients (15 %) remained in NYHA class III after 6 months of follow-up, one of them underwent repeated alcohol septal ablation with successful improvement at 6 months follow-up, and the other two patients awaiting reevaluation at 6 months to decide for repeating ASA. Significant reduction of left ventricle outflow gradients (LVOTG) and septal thickness were observed during 6 months follow-up. Beyond 6 months, except for 3 patients, there was no further decrease in either septal thickness or LVOTG noted. The incidence of right bundle branch block (RBBB) after ASA was 45 % % and 3 patients (15 %) needed PPM implantation. There was no cardiovascular death on follow-up. Conclusion: Alcohol septal ablation is a safe and effective option for severely symptomatic patients, less than 60m years with HOCM because of its low risk and its significant clinical, echocardiographic, and hemodynamic improvement. The overall in-hospital adverse cardiovascular events were low and few patients required in-hospital permanent pacemaker implantation.

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“…A total of 40 studies including 22 ASA studies 4,12-32 and 23 SM cohorts 10,11,18,25,30,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] S1.…”

Section: Resultsmentioning

confidence: 99%

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta‐analysis

Kheiri

Osman

Barbarawi

et al. 2018

Clinical Cardiology

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Background: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are effective therapies for patients with hypertrophic cardiomyopathy who remain symptomatic despite medical therapy. A plethora of data has recently emerged on the long-term outcomes of these procedures.We hence sought to perform an updated meta-analysis comparing both procedures.Methods: Studies reporting long-term (>3-years) outcomes of SM and/or ASA were included.The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, sudden cardiac death (SCD), reintervention, and complications including death, pacemaker implantation, and stroke.Results: Twenty-two ASA cohorts (n = 4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up = 6.8-years) were included. Septal myectomy was associated with higher periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs 0.8% P = 0.013, respectively), but ASA was associated with more need of pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause mortality, cardiovascular mortality, and sudden cardiac death rates were 1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and 0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43), respectively. Repeat septal reduction intervention(s) were more common after ASA (11% vs 1.5%, P < 0.001). Conclusion:Compared with SM, ASA is associated with lower periprocedural mortality and stroke but higher rates of pacemaker implantations and reintervention. However, there was no difference between ASA and SM with regards to long-term all-cause mortality, cardiovascular mortality, or SCD.

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Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: A 16-Year Australian Single Centre Experience

Cited by 11 publications

References 37 publications

Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: A propensity score–matched cohort

Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: A propensity score–matched cohort

Outcomes and Complications of alcohol septal ablation for younger patients with hypertrophic obstructive cardiomyopathy: a single-centre study

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta‐analysis

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