Cyanoacrylate for Septal Ablation in Hypertrophic Cardiomyopathy

Abstract

GSA seems to be an efficient and safe approach to HOCM, especially in patients with the collateral formation. Further experience is needed in order to assess the long-term efficacy and safety of this technique.

Septal reduction therapy using nonalcohol agent in hypertrophic obstructive cardiomyopathy: Single center experience

“…We reported a similar improvement in NYHA functional class symptoms, reductions of LVOT gradient and mitral regurgitation when compared with ASA trials [17,26,27]. In contrast, the reduction of interventricular septal thickness seemed to be lower than to those previously reported with alcohol but EVOH septal ablation reduced interventricular septal thickness similar to non-ASA trial [7,23,28,29]. In addition, the infarct size seemed to be smaller than those reported with ASA regarding the peak of CK MB level.…”

“…Van Dockum et al in their study with ASA, peak CK-MB value was measured 217 6 95 ng/ ml [30]. In our center, in a prior study, an alternative method for septal ablation using cyanoacrylate was evaluated, and peak serum CK-MB and troponin T levels were measured 47.9 6 20.7 and 0.9 ng/ml, respectively [7]. The reason for these results is EVOH is better to penetrate to the deep artery and microvascular circulation than other non-ASA agents.…”

Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: From Experiment to Standard of Care

“…From 1995 onwards, therapeutic options for HOCM dramatically changed by the introduction of percutaneous septal ablation [ 99 – 140 ]. In 1994, after obtaining ethical approval for a limited series of cases to undergo this new procedure, Sigwart performed the first three septal ablations in elderly, highly symptomatic HOCM patients who were unable to tolerate surgical myectomy.…”

“…Significant reductions in LVOT obstruction were observed, but long-term durability of this technique has not yet been demonstrated. Other cytotoxic agents that may be used are microcoils or contour emboli, and a small series with less favorable results reported on the use of radiofrequency energy [ 139 , 140 ] applied either from the right ventricular septum or directly to the left ventricular septum.…”

Alcohol Septal Ablation for the Treatment of Hypertrophic Obstructive Cardiomyopathy

“…• Microcoils, polyvinyl alcohol foam and cyanoacrylate glue delivered in the target septal artery obstruct the vessel with infarction of the subtended myocardium. [84][85][86][87] • Direct endocavitary radiofrequency or cryotherapy ventricular ablation. 88,89 This approach has the advantage of overcoming unfavourable septal anatomy.…”