A prospective follow-up of alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy-The baylor experience (1996-2002)

Abstract

Background: There is a paucity of data on the long‐term outcome of alcohol septal ablation (ASA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Hypothesis: The study was undertaken to evaluate the longer‐term outcome of ASA therapy for symptomatic HOCM. Methods: In all, 137 patients were enrolled consecutively (1996–1999) and 130 (95%) (74 men, 56 women, aged 51 ± 17 years) underwent ASA and had serial prospective follow‐up for up to 5 years (mean follow‐up 3.6 ± 1.4 years). Evaluation included angina (Canadian Cardiovascular Society [CCS] score), dyspnea (New York Heart Association [NYHA] class), duration of exercise on treadmill, and echocardiographic indices. Results: Ethanol (3.5 ± 1.5 cc), injected into 1.5 ± 0.6 arteries, induced a mean peak plasma creatine kinase (CK) of 1676 ± 944 units. Complications of procedures included death 1.5% (2/130), heart block requiring permanent pacemaker 13% (17/130), and coronary dissection 4.4% (6/130). Baseline versus last follow‐up visit: NYHA class decreased from 3.0 ± 0.4 to 1.2 ± 0.6 (p < 0.01); CCS angina score from 2.0 ± 0.8 to 0.08 ± 0.4 (p < 0.01); and duration of exercise increased from 322 ± 207 to 443 ± 200s (p < 0.01). Resting left ventricular outflow tract gradient at baseline versus last follow‐up visit showed a decrease from 74 ± 30 to 4 ± 13 (p < 0.01), and the dobutamine‐provoked gradient of 88 ± 29 decreased to 21 ± 21 (p < 0.01) mmHg. All‐cause mortality over the duration of follow‐up was 7.7% (10) giving an annual rate of 2.1%, and cardiac mortality was 2.3% (3) reflecting an annual rate of 0.6%. Conclusions: Alcohol septal ablation decreased symptoms and improved exercise performance, indicating that it is an effective procedure for symptomatic HOCM.

A Decade of Percutaneous Septal Ablation in Hypertrophic Cardiomyopathy

“…Although occasionally a stiffer wire offering increased support may be needed, the use of softer wires has been shown to reduce the risk of coronary damage. 35 With the guidewire in the septal branch, a short (≤10 mm long) over-the-wire balloon is advanced into the septal branch and inflated at the nominal pressure. It is essential that the balloon catheter should be compatible with the injection of absolute alcohol.…”

“…Results of longer follow-up, however, confirm the safety and efficacy of alcohol septal ablation ( Table 2). [32][33][34][35][36][37][38] In a cohort of the first 100 patients treated the overall survival was 96% at 8 years, and 74% of patients remained free of severe symptoms, atrial fibrillation, stroke or ICD implantation. 32 A larger cohort of 347 patients, also treated with the echocardiography-guided technique, has shown 94% survival after 5 years and 87% after 10 years.…”

“…79 Damage to the coronary arteries with the guidewire or balloon inflation is a rare complication and can be avoided with increasing experience and use of proper equipment. 35 Alcohol leakage to the LAD artery is also uncommon, but can be disastrous for the patient. 41, 80 The use of a slightly oversized balloon catheter, with slow and watchful injection of alcohol and deflation of the balloon at least 10 min after the last alcohol injection will effectively prevent retrograde alcohol flow to the LAD artery, 31 and meticulous angiographic demonstration of the target septal branch before alcohol injection will reveal the existence of collateralization between septal branches (Figure 3).…”

Alcohol septal ablation in hypertrophic cardiomyopathy utilizing a longitudinal 17-year study (mean 10.8). Observation follow-ups taken at a single medical centre

“…There are few works assessing ASA efficacy in the long-term perspective through the course of the disease in treated patients and other concomitant diseases. Observation of a group of patients who undergo this treatment for a period more than 10 years is rare [20][21][22][23][24]. All patients in the present study achieved a lasting reduction of the gradient in LVOT below 30 mm Hg within at least 3 years of observation, only 1 person required a repeated treatment after 1 year.…”

Resultados a longo prazo da miectomia septal no tratamento da cardiomiopatia hipertrófica

“…These procedures, which seek to relieve the left ventricular obstruction and reduce systolic anterior motion of mitral valve have become widely accepted and have presented rapid growth [18].…”