Septal myectomy after failed septal alcohol ablation

Bajona, Pietro; Arguís, M.J.; Prat‐González, Susanna

doi:10.21037/acs.2017.05.11

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…Some researchers believe that the alleviation of LVOT obstruction is achieved by the change in the left ventricular contraction sequence caused by conduction damage (17). In addition, the present study revealed that the risk of AVB after SSM alone is low, but concomitant preoperative RBBB increases the risk of AVB after surgery (13,18), and postoperative PPM affects long-term survival (13). Previous reports of ASA for the treatment of OHCM showed that ASA is associated with right bundle branch injury (19), with an incidence rate as high as 58% (8,20,21).…”

Section: Discussionsupporting

confidence: 49%

Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation

Yang¹,

Zhu²,

Cui³

et al. 2021

J Thorac Dis

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Background: Although surgical treatment of residual obstruction after alcohol septal ablation (ASA) is often challenging in patients with obstructive hypertrophic cardiomyopathy (OHCM) there are very few relevant clinical reports. Thus, outcomes of surgical septal myectomy (SSM) in this subgroup of patients remain to be determined. Therefore, this study aimed to determine the surgical and follow-up outcomes in patients with OHCM exhibiting residual obstruction after ASA. Methods: We collected case data for 62 patients with OHCM and residual obstruction after ASA who underwent SSM at Fuwai Hospital between January 2002 and June 2019. Propensity score matching with patients having had a myectomy as the only invasive procedure-was conducted in a 1:2 ratio.Echocardiography parameters, surgery results, and follow-up outcomes were compared between the groups. Results: The prior ASA group had a higher incidence of complete atrioventricular block (AVB) and subsequently postoperative permanent pacemaker (PPM) implantation than the primary myectomy group (9.7% vs. 1.6%, P=0.01). Two patients died within 30 days after surgery in the prior ASA group, and one patient died in the primary myectomy group, with an operative mortality rate of 3.2% and 0.8%, respectively (P=0.2). The 5-year event-free survival rate was 86.0% in the prior ASA group (median follow-up period: 3.2 years; mean: 3.9±2.6 years; maximum, 10.6 years) and 88.5% in the primary myectomy group (median follow-up period: 2.4 years; mean 2.8±1.7 years; maximum, 9.1 years) (P=0.2). During follow-up, four of 62 (6.5%) patients in the prior ASA group and one of 124 (0.8%) patients in the primary myectomy group progressed to advanced heart failure (P=0.025). Conclusions: Patients with OHCM following ASA are at an increased risk of developing AVB after SSM.Their surgical outcomes, and long-term survival rate were satisfactory and, osimilar to those for patients having had a myectomy as the only invasive procedure. In addition, they had an increased risk of advanced heart failure after SSM in the present study.

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Section: Discussionsupporting

confidence: 49%

Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation

Yang¹,

Zhu²,

Cui³

et al. 2021

J Thorac Dis

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“…In this series, surgical myectomy rather than repeat ASA appeared to be the favored intervention for residual outflow tract obstruction after unsuccessful ASA; however, operation in this setting can be problematic. 29,30 In a review of 31 patients who underwent septal myectomy after failed alcohol ablation, Quintana and coauthors 31 noted a higher risk of postoperative complete heart block in patients who had prior ASA compared with a control group of patients who had myectomy without a history of ASA (19.4% vs 1.6%). The increased risk of heart block observed with septal myectomy after ASA may be explained by the differential effects of each procedure on the conduction system.…”

Section: Septal Myectomy After Unsuccessful Ablationmentioning

confidence: 99%

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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“…Additionally, the few CMR images available in the present study revealed that the underlying mechanism of previously failed ASA might be attributed to variable extent and uncontrollable location of infarcted myocardium induced by ASA. This finding was consistent with the study by Valeti et al Several mechanisms have been proposed to address the failure of ASA in some HOCM patient population . Unlike the surgical septal myectomy which provides precise and discrete resection, ASA induces myocardial infarction of hypertrophic basal septum through perforator artery.…”

Section: Discussionmentioning

confidence: 99%

“…This finding was consistent with the study by Valeti et al 18 Several mechanisms have been proposed to address the failure of ASA in some HOCM patient population. 14,19 Unlike the surgical septal myectomy which provides precise and discrete resection, ASA induces myocardial infarction of hypertrophic basal septum through perforator artery. The effects are limited by anatomical morphology, perforator artery distribution, and collateralization.…”

Section: Discussionmentioning

confidence: 99%

Predictors of long‐term outcome after septal myectomy in symptomatic hypertrophic obstructive cardiomyopathy patients with previous alcohol septal ablation and residual obstruction

Zhu

Tang

Cui

et al. 2019

Journal of Cardiac Surgery

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Background and aim Recently alcohol septal ablation (ASA) has emerged as an alternative treatment for drug‐refractory hypertrophic obstructive cardiomyopathy (HOCM) and a subgroup of HOCM patients with previous ASA may need myectomy. However, subsequent outcome and mechanism of residual obstruction has not been determined. This study aims to determine outcome after myectomy and mechanism of residual obstruction in HOCM patients with previous ASA. Methods From February 2009 to June 2017, 38 HOCM patients with previous ASA underwent surgical septal myectomy at our institution. Seventy‐six patients who underwent surgical septal myectomy initially were included as the comparison group through one‐to‐two propensity score matching method. Results Fourteen available cardiac magnetic resonance images revealed inferior location and small area of infarcted myocardium induced by ASA in 12 patients and outside targeted location in two patients. During follow‐up (median, 2.4; maximum, 7.8 years), event‐free survival at 7 years was 83.2% in the previous ASA group and 94.6% in the comparison group, respectively (P = 0.0378). Multivariable analysis indicated previous ASA (hazard ratio, 4.28; 95% confidence intervals [CI], 1.20‐15.26; P = 0.025) and postoperative left ventricular end‐diastolic diameter (hazard ratio, 1.14; 95% CI, 1.05‐1.23; P = 0.002) were independent predictors of adverse events. Conclusions This study demonstrated that uncontrollable extent and location of infarcted myocardium induced by ASA may attribute to residual obstruction after previous ASA, and the long‐term event‐free survival after myectomy was inferior. It may provide special precaution to patient selection and the increased number of ASA practiced worldwide.

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Septal myectomy after failed septal alcohol ablation

Cited by 7 publications

References 51 publications

Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation

Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation

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

Predictors of long‐term outcome after septal myectomy in symptomatic hypertrophic obstructive cardiomyopathy patients with previous alcohol septal ablation and residual obstruction

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