Original title: Periprocedural Complication and Long-Term Outcome After Alcohol Septal ablation in hypertrofic Obstructive cardiomyopathy. A Single-Center Experience. Reference: Robbert Steggerda, et al. J Am Coll Cardiol Intv 2014;7:1227-34.
Septal ablation is an alternative to surgery in hypertrophic cardiomyopathy (HCM), but indications and evolution are not fully established.161 patients who received septal ablation (SA) and 102 who received surgical myomectomy were analyzed retrospectively, between 1981 and 2010 at a single center.
Characteristics of both groups were similar although the SA group had older age, presence of angina and slightly higher interventricular septum and secondly coronary revascularization was more frequentin the surgery group.At 30 days, major complications (death, stroke, ventricular fibrillation / ventricular tachycardia) were similar, but considering all the complications, these were lower in the SA group (14% versus 28% 0.004).
The long-term follow up was achieved in 99% of patients (261/263); the maximum time was 11 years and the mean of 9 years for myomectomy and 5 for the SA.No differences in mortality, stroke, syncope, functional class, re-hospitalizations, and implanted defibrillator or re- interventions were observed.Both the basal gradient as that caused were higher in the SA group (9 mmHg versus 10 mmHg; p = 0.003 and 10 mmHg versus 19 mmHg; p <0.001).The only predictor of events in the multivariate analysis was age.
Conclusion
The survival and clinical outcomes are good and comparable between septal ablation and surgical myomectomy. Myomectomy presented more periproceduralcomplications, longer hospital stay, and septal ablation higher residual gradient.
Comment
The need for intervention in hypertrophic cardiomyopathy is low because the drug treatment and pacemaker implantation has proven effective. The significant point about this analysis is that the percutaneous route has fewer total complications and shorter hospital stay with a similar long-term evolution.One of the main limitations is that this is a retrospective study from a single center, however it provides important information, still needs further investigations.
Courtesy Carlos Fava MD
Interventional cardiologist
Favaloro Foundation
Buenos Aires – Argentina
Carlos Fava