Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction

Yang, Yujun; Fan, Chaomei; Yuan, Jinqing; Wang, Shuiyun; Song, Yue; Qiao, Shubin; Shang, You; Wang, Zhimin; Duan, Fujian; Li, Yishi

doi:10.1111/joic.12331

Cited by 16 publications

(22 citation statements)

References 28 publications

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“…Echocardiographic measurements were made according to current guidelines 13 . Specifically, maximal left ventricular wall thickness (MLVWT) was measured in the parasternal long-axis or parasternal short-axis views (2D or M-Mode) at end diastole.…”

Section: Methodsmentioning

confidence: 99%

Clinical presentation and survival of childhood hypertrophic cardiomyopathy: a retrospective study in United Kingdom

Norrish

Field

McLeod

et al. 2018

European Heart Journal

127

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AimsUnderstanding the spectrum of disease, symptom burden and natural history are essential for the management of children with hypertrophic cardiomyopathy (HCM). The effect of changing screening practices over time has not previously been studied. This study describes the clinical characteristics and outcomes of childhood HCM over four decades in a well-characterized United Kingdom cohort.Methods and resultsSix hundred and eighty-seven patients with HCM presented at a median age of 5.2 years (range 0–16). Aetiology was: non-syndromic (n = 433, 63%), RASopathy (n = 126, 18.3%), Friedreich’s ataxia (n = 59, 8.6%) or inborn errors of metabolism (IEM) (n = 64, 9%). In infants (n = 159, 23%) underlying aetiology was more commonly a RASopathy (42% vs. 11.2%, P < 0.0001) or IEM (18.9% vs. 6.4% P < 0.0001). In those with familial disease, median age of presentation was higher (11 years vs. 6 years, P < 0.0001), 141 (58%) presented <12 years. Freedom from death or transplantation was 90.6% (87.9–92.7%) at 5 years (1.5 per 100 patient years) with no era effect. Mortality was most frequently sudden cardiac death (SCD) (n = 20, 2.9%). Children diagnosed during infancy or with an IEM had a worse prognosis (5-year survival 80.5% or 66.4%). Arrhythmic events occurred at a rate of 1.2 per 100 patient years and were more likely in non-syndromic patients (n = 51, 88%).ConclusionThis national study describes a heterogeneous disease whose outcomes depend on the age of presentation and aetiology. Overall mortality and SCD rates have not changed over time, but they remain higher than in adults with HCM, with events occurring in syndromic and non-syndromic patients.

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Section: Methodsmentioning

confidence: 99%

Clinical presentation and survival of childhood hypertrophic cardiomyopathy: a retrospective study in United Kingdom

Norrish

Field

McLeod

et al. 2018

European Heart Journal

127

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“…Even when, in some patients, ASA leaves a small area of upper septal hypertrophy, the remodeling of the segment as well as the resulting right bundle branch block in most patients causes dyssynchronous LVOT and less obstruction [ 43 ], with its implications on symptomatic improvement. Conversely, SM entails shaving a significant segment of the upper septal myocardium, thus achieving a wider outflow tract with an expected larger remodeling region as our analysis showed, which also explains the fewer long term associated symptoms we found [ 22 , 27 , 30 ]. The interaction between symptomatic improvement and degree of fall of LVOT obstruction in females could be explained on the basis of better relief of LVOT resistance in the subset of patients with baseline signs of stiff LV, as shown in the larger left atrium which reduced in size at follow up.…”

Section: Discussionmentioning

confidence: 85%

“…Of 7638 articles identified in the initial searches, 645 studies were considered as potentially relevant. After a stringent selection process, 20 articles met the inclusion criteria [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Two of them were CTs [ 31 , 33 ] and 18 cohort studies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 34 , 35 , 36 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…The intriguing part of our analysis is the long term related greater reduction of LVOT gradient in the SM group compared to the ASA group, which seems to be associated with better improvement of symptoms compared to the ASA patients. This difference is despite similar changes in LV dimensions and ejection fraction [ 27 , 29 , 30 ]. With improvements in ASA techniques, and the use of small balloons and the injection of only 1 mL of pure alcohol to induce a small infarct area, investigators reported better procedure outcomes in terms of incidence of heart block and arrhythmias [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Alcohol Septal Ablation versus Septal Myectomy Treatment of Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Bytyçi

Nistri²,

Mörner

et al. 2020

JCM

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Surgical myectomy (SM) and alcohol septal ablation (ASA) are two invasive therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), despite medical therapy. This meta-analysis aims to compare the efficacy of the two procedures. We searched all electronic databases until February 2020 for clinical trials and cohorts comparing clinical outcomes of ASA and SM treatment of patients with HOCM. The primary endpoint was all-cause mortality, cardiovascular (CV) mortality, sudden cardiac death (SCD), re-intervention, and complications. Secondary endpoints included relief of clinical symptoms and drop of left ventricular outflow tract (LVOT) gradient. Twenty studies (4547 patients; 2 CTs and 18 cohorts) comparing ASA vs. SM with a mean follow-up of 47 ± 28.7 months were included. Long term (8.72 vs. 7.84%, p = 0.42) and short term (1.12 vs. 1.27%, p = 0.93) all-cause mortality, CV mortality (2.48 vs. 3.66%, p = 0.26), SCD (1.78 vs. 0.76%, p = 0.20) and stroke (0.36 vs. 1.01%, p = 0.64) were not different between procedures. ASA was associated with lower peri-procedural complications (5.57 vs. 10.5%, p = 0.04) but higher rate of re-interventions (10.1 vs. 0.27%; p < 0.001) and pacemaker dependency (12.4 vs. 4.31%, p = 0.0004) compared to SM. ASA resulted in less reduction in LVOT gradient (−47.8 vs. −58.4 mmHg, p = 0.01) and less improvement of clinical symptoms compared to SM (New York Heart Association (NYHA) class III/IV, 82.4 vs. 94.5%, p < 0.001, angina 53.2 vs. 84.2%, p = 0.02). Thus, ASA and SM treatment of HOCM carry a similar risk of mortality. Peri-procedural complications are less in alcohol ablation but re-intervention and pacemaker implantations are more common. These results might impact the procedure choice in individual patients, for the best clinical outcome.

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“…However, another previous study compared the effectiveness of ASA and transaortic extended myectomy (TEM) in HCM with MVO. The results indicated that TEM may provide a more reliable reduction in gradients compared to ASA, while serious ventricular arrhythmias were uncommon after either of the two therapies (19). Furthermore, a recent clinical study reported that surgical myectomy appeared to be protective against further malignant arrhythmias (20).…”

Section: Discussionmentioning

confidence: 98%

Ventricular tachycardia and heart failure in a patient of mid‑ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: A case report

Zhang

Liu

2019

Exp Ther Med

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Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHC) with apical aneurysm is a rare type of cardiomyopathy. It is associated with an elevated risk of ventricular arrhythmias, thromboembolism, heart failure and sudden cardiac death. The present case study reports on a patient with MVOHC and apical aneurysm who developed ventricular arrhythmias and heart failure. The patient received an implantable cardioverter defibrillator for prevention of fatal arrhythmias. Ventricular tachycardia was terminated by increased doses of amiodarone and β-blocker. Transthoracic echocardiography indicated a mid-ventricular gradient of 64 mmHg. The patient refused surgical treatment and opted for alcohol septal ablation (ASA). At the 6-month follow-up, a rebound of the gradient following ASA was observed on echocardiography. In the present study, timely recognition of MVOHC with apical aneurysm led to prompt defibrillator implantation for prophylaxis regarding further malignant arrhythmias. Surgical management should be considered in symptomatic patients with MVOHC and apical aneurysm.

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Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction

Abstract: While ASA and TEM both improve gradients and symptoms, TEM may provide a more reliable reduction in gradients compared to ASA.

Cited by 16 publications

References 28 publications

Clinical presentation and survival of childhood hypertrophic cardiomyopathy: a retrospective study in United Kingdom

Clinical presentation and survival of childhood hypertrophic cardiomyopathy: a retrospective study in United Kingdom

Alcohol Septal Ablation versus Septal Myectomy Treatment of Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Ventricular tachycardia and heart failure in a patient of mid‑ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: A case report

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