Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

Achim, Alexandru; Șerban, Adela; Moț, Ștefan; Leibundgut, Gregor; Marc, Madalin; Sigwart, Ulrich

doi:10.1002/ehf2.14272

Cited by 21 publications

(17 citation statements)

References 51 publications

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“…HCM can cause sudden cardiac death, heart failure death, and death due to stroke. 41 Approximately 10% of patients died within 1 year after surgery in the present study. This is a higher mortality rate than what has been reported.…”

Section: Results In Contextmentioning

confidence: 52%

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

et al. 2023

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Aims Prior studies have suggested causal relationships between obesity and acute cardiovascular events. It has been also known that the risk of acute cardiovascular events is reduced by bariatric surgery. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy (HCM). In this context, we aimed to investigate whether bariatric surgery is associated with a reduced risk of cardiovascular‐related acute care use in patients with HCM. Methods and results In this population‐based study, the bariatric surgery group consisted of patients with HCM who underwent bariatric surgery from January 2004 to December 2014. The control group included those who have obesity and HCM and received non‐bariatric elective intra‐abdominal surgery during the same period. The outcome was cardiovascular‐related acute care use (i.e. emergency department (ED) visits or unplanned hospitalizations for cardiovascular disease) during a 1‐year post‐surgery period. We used the SPARCS database, a population‐based ED and inpatient database in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6‐month post‐surgery periods. We adjusted for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2 years before the index surgery, and the Elixhauser co‐morbidity measures. We also performed propensity score (PS)‐matching and inverse probability treatment weighting analyses using these variables. The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 in the control group. The risk was not significantly different in the 1–6 months post‐surgery period. By contrast, in the 7–12 months post‐surgery period, the risk of cardiovascular‐related acute care use was significantly lower in the bariatric surgery group (adjusted odds ratio 0.23; 95% CI 0.068–0.71; P = 0.01) compared with the control group. In the PS‐matched cohort, there were no significant differences in the baseline characteristics. The PS‐matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7–12 months post‐surgery period. The inverse probability treatment weighting analysis replicated the findings. Conclusions Bariatric surgery was associated with a lower risk of cardiovascular‐related acute care use in the 7–12 months post‐surgery period in this population‐based study.

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Section: Results In Contextmentioning

confidence: 52%

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

et al. 2023

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“…Therefore, this procedure is not recommended in the case of pre-existing left bundle branch block (unless a pacemaker has been previously implanted). On the other hand, as surgical myectomy can be associated with the development of a left bundle branch block, alcohol septal ablation is favored in patients with pre-existing right bundle branch block [35][36][37]. Finally, comprehensive morphological and angiographic assessment by cardiac ultrasound, CMR, CT-angiography, and/or invasive coronary angiography is essential to assess whether the patient can successfully undergo the procedure.…”

Section: Historical Clinical and Procedural Considerationsmentioning

confidence: 99%

“…This condition is an absolute contraindication to alcohol injection because of the risk of potentially life-threatening complications such as extensive myocardial infarction. Intracoronary contrast echocardiography performed during the procedure is recommended in all patients undergoing ASA to ensure the size and the localization of iatrogenic myocardial infarct, prevent adverse events, and assess procedural success [36].…”

Section: Pre-procedural Anatomic Evaluationmentioning

confidence: 99%

“…The goal of alcohol septal ablation is to achieve a significant and sustained improvement in symptoms and to reduce LVOT gradient by >50%. Additional beneficial effects include a reduction in mitral regurgitation and left ventricular end-diastolic pressure, which results in a lower incidence of atrial fibrillation and an improvement in pulmonary hypertension [36,52]. Favorable cardiac remodeling is also an important effect of the procedure, particularly in young patients, and may be clinically evident after 12 months [33,53].…”

Section: How To Assess Procedural Success?mentioning

confidence: 99%

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Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective

Gragnano

Pelliccia

Guarnaccia

et al. 2023

JCM

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Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient’s hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients—the Cardiomyopathy Team.

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“…How to abolish both LVOTO and mitral regurgitation with minimum risk to the patient? A variety of interventional strategies have been developed: for such a heterogenous disease, with therapeutic aims encompassing symptomatic as well as prognostic goals, it is not surprising that there has been considerable debate regarding ‘optimal’ intervention strategy [3]. In fact, there is a place for all these therapies, and most HCM centres use personalized approaches based on holistic patient factors as well as detailed disease characteristics.…”

Section: Introductionmentioning

confidence: 99%

The mitral valve in hypertrophic cardiomyopathy

Malcolmson

Shipolini

Mohiddin

et al. 2023

Current Opinion in Cardiology

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Purpose of review Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities. Recent findings The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options. Summary Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.

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Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

Cited by 21 publications

References 51 publications

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective

The mitral valve in hypertrophic cardiomyopathy

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