Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Veselka, Josef; Faber, Lothar; Jensen, Morten Kvistholm; Cooper, Robert; Januška, Jaroslav; Krejčí, Jan; Bartel, Thomas; Dąbrowski, M; Hansen, Peter Riis; Almaas, Vibeke Marie; Seggewiß, Hubert; Horstkotte, Dieter; Adlová, Radka; Bundgaard, Henning; Berg, Jurriën Ten; Liebregts, Max

doi:10.1016/j.cjca.2017.10.020

Cited by 47 publications

(33 citation statements)

References 22 publications

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“…6 Additionally, experienced centers have demonstrated a very low procedure-related mortality rate. 4,5 Therefore, even with the absence of randomized trials, based on recent observational outcomes only, we have become more liberal in selecting patients for ASA, bearing in mind patients' preferences and real physical limitations in their life (►Table 1).…”

Section: Patient Selectionmentioning

confidence: 99%

“…ASA is described as an interventional procedure guided by myocardial contrast echocardiography and the first septal branch is considered as the usual target of alcohol injection. 1,[4][5][6][7][8] The morphological result of ASA should be similar to myectomy which is difficult to achieve in all patients because of anatomical variations of septal branches. A preprocedural computerized tomography coronary angiography could benefit in identifying the optimal septal (sub)branch.…”

Section: Have a Planmentioning

confidence: 99%

“…Improvement of patients' symptoms after ASA is expected in 90% of the patients, with a mean reduction of LVOT pressure gradient of 75% and final New York Heart Association (NYHA) class reduction of approximately 1.5. 1,[4][5][6][7][8] The immediate post-ASA reduction of LVOT obstruction, caused by necrosis and a subsequent stunning of the heart, is followed by a transient pressure gradient increase in the first post-ASA week, and is later followed by a gradual LVOT obstruction reduction/elimination in the following months. 12,13 This reduction is caused by shrinking of the ablated septum.…”

Section: Hemodynamic and Clinical Improvementmentioning

confidence: 99%

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Ten Tips and Tricks for Performing Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Veselka

2020

Int J Angiol

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Alcohol septal ablation (ASA) is an effective interventional therapeutic strategy to reduce or eliminate left ventricular outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM). Although ASA was introduced 25 years ago, there are still no available guidelines to follow. Therefore, most interventional cardiologists rely on their own experience, which is often limited by a relatively low number of performed procedures. This paper presents ten tips and tricks to safe and effective ASA for HOCM.

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Section: Patient Selectionmentioning

confidence: 99%

Section: Have a Planmentioning

confidence: 99%

Section: Hemodynamic and Clinical Improvementmentioning

confidence: 99%

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Ten Tips and Tricks for Performing Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Veselka

2020

Int J Angiol

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“…Indeed, concern regarding residual left ventricular outflow tract (LVOT) gradients and risk of iatrogenic ventricular septal defects has led many cardiologists to use alcohol septal ablation as first line therapy for obstructive HCM refractory to medical therapy. 2 At institutions that evaluate and treat large numbers of patients with HCM, transaortic myectomy can be performed with very low operative risk and reliable relief of outflow tract gradients. 3,4 Patient selection is based on symptomatic status and preoperative imaging.…”

Section: Introductionmentioning

confidence: 99%

Transaortic Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy

Nguyen

Schaff

2017

Operative Techniques in Thoracic and Cardiovascular Surgery

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Transaortic extended septal myectomy is the best treatment option for patients with obstructive hypertrophic cardiomyopathy whose symptoms are refractory to medical management. In this article, we describe our operative technique of transaortic septal myectomy, which relieves subaortic left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve associated with hypertrophic cardiomyopathy. In experienced centers, surgical outcomes are excellent (operative mortality <1%) and long-term symptomatic relief is achieved in the majority of patients. Operative Techniques in Thoracic and Cardiovasculary Surgery 22:200À215

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“…Current evidence in the ASA field is encouraging and suggests that this interventional procedure can positively affect lives of HOCM patients, especially if they are treated in centres dedicated to hypertrophic cardiomyopathy [13].…”

mentioning

confidence: 99%

Update on alcohol septal ablation for hypertrophic obstructive cardiomyopathy

2019

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Article Dąbrowski et al., see p. 181 The first alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) was performed by Ulrich Sigwart, and the description of the procedure was published in The Lancet in 1995 [1]. Currently, based on the increasing body of evidence, it is known that severe and symptomatic left ventricular obstruction usually needs effective mechanical relief in the form of septal reduction therapy (ASA or myectomy) [2]. The technique of ASA involves an injection of a small amount (1-3 mL) of desiccated alcohol into an appropriate septal branch [3-6]. The rapid postprocedural pressure gradient decrease is caused mainly by stunning and myocardial necrosis. However, the main mechanism of the continuous pressure gradient relief is the widening of the left ventricular outflow tract developing secondarily to infarction and fibrosis of the basal septum. Subsequently, the basal septal shrinking is followed by a gradual reduction in the left ventricular mass, improvement of the diastolic function, and reduction in the degree of mitral regurgitation [3-7]. Also, successful procedures lead to an improvement in symptoms of angina pectoris and dyspnoea [3-7]. The first European multinational study focused on early outcomes of ASA undoubtedly demonstrated its clinical efficacy, but the safety of this interventional procedure was limited as complete heart blocks occurred in one-third of the procedures and one-tenth of the patients needed permanent pacing after ASA [7, 8]. It was also found that in the younger HOCM patients, characterised by a thicker basal septum, post-ASA haemodynamic improvement was slower, but the procedure was effective irrespective of the age of the treated patients [9]. Although encouraging results of single-centre or national ASA registries were published in the first two decades after the first procedure performed by Sigwart, the long-term safety and efficacy of ASA have been a matter of ongoing debate.

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Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Cited by 47 publications

References 22 publications

Ten Tips and Tricks for Performing Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Ten Tips and Tricks for Performing Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Transaortic Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy

Update on alcohol septal ablation for hypertrophic obstructive cardiomyopathy

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