Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry

Abstract

The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.

Septal myectomy after failed septal alcohol ablation

“…Historically, hemodynamic success after ASA is reported to be 70%, with an approximate 20% incidence of recurrence of severe symptoms (20). In the most recent registries (10,11), the percentage of patients who are lost at gradient/symptomatic follow-up or suffering obstruction requiring repeated SRT is 15-18%. Such numbers should be taken in serious considerations especially in view of the aforementioned limited follow-up in ASA and with the low rates of reoperation after septal myectomy that nowadays are well below 2% (21).…”

Short and long-term outcomes of alcohol septal ablation with the trans-radial versus the trans-femoral approach

“…Alcohol septal ablation (ASA) has become a common procedure to reduce left ventricular outflow tract gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM) refractory to maximal medical therapy [1][2][3][4][5][6][7][8]. The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines recommend ASA over surgical myomectomy mainly in patients considered high risk for surgery, particularly in the elderly [9], while the ESC guidelines [10] recommend the use of septal reduction therapy in symptomatic patients with an LVOT gradient N 50 mmHg provided that the septal reduction therapy is performed by experienced operators working as a part of a multidisciplinary team expert in the management of HOCM.…”

Alcohol septal ablation: patient selection and rationality of its application

“…1 представлена теоретическая зависимость частоты имплантированных постоянных электрокарди-остимуляторов (ЭКС), а также частоты резидуальной обструкции от толщины перегородки [2,10,12,[14][15][16]. При сопоставлении результатов разных научных групп можно предположить, что наиболее оптимальной тол-щиной МЖП на уровне обструкции для этаноловой септальной аблации является толщина 20-22 мм.…”

“…10% потребо-вались повторные интервенции в связи с остаточной обструкцией: 7% -повторная этаноловая септальная аблация, 3% -хирургическая миэктомия. Также от-мечено, что остаточная постпроцедурная обструкция ассоциирована c негативным прогнозом и «неудовлет-ворительным» функциональным статусом [16]. Nagueh S.F.…”