Long-Term Outcomes in High-Risk Symptomatic Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation

Kwon, Deborah; Kapadia, Samir; Tuzcu, E. Murat; Halley, Carmel; Gorodeski, Eiran Z.; Curtin, Ronan J.; Thamilarasan, Maran; Smedira, Nicholas G.; Lytle, Bruce W.; Lever, Harry M.; Desai, Milind Y.

doi:10.1016/j.jcin.2008.05.009

Cited by 75 publications

(58 citation statements)

References 32 publications

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“…There were reports demonstrating the survival advantage of patients younger than 60 years or 65 years [25,28]. Besides, survival of the ASA group in this study was comparable to one cohort with a mean age of < 50 years, which supports this viewpoint as well [29].…”

Section: Discussionsupporting

confidence: 85%

“…Several studies suggested age as an independent predictor of adverse events [8,21,25,28], whereas Cox regression analysis did not identify this variable as an independent risk factor of primary or secondary end point in this study, which was in line with Veselka et al [29]. We should note that age-related adverse events mainly occurred in patients older than 60 years [8,25,28].…”

Section: Discussionsupporting

confidence: 81%

“…The relatively better survival of the ASA group in this study vs. several previous reports may be explained by the fact that patients in the ASA group of our study were younger (mean age: 49.8 years) than those from the other studies (mean age: 54-64 years) [8,[25][26][27]. There were reports demonstrating the survival advantage of patients younger than 60 years or 65 years [25,28].…”

Section: Discussioncontrasting

confidence: 61%

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Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

et al. 2015

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 61%

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Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

et al. 2015

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“…10-year data from this same registry showed 5.1% allcause mortality and total in-hospital mortality at 1.2% in all patients [13]. Poor outcome was associated with old age [13,14] and lower alcohol dosage and the absence of atrial fibrillation as independent predictors of reduced cardiac mortality [13]. Furthermore, comparative nonrandomized studies show that myomectomy and alcohol ablation are similarly associated with subjective improvement in NYHA functional class, but surgery yields more favorable outcomes with fewer early complications, more complete relief of obstruction, and greater exercise capacity and oxygen consumption [15].…”

Section: Limitations Of Asamentioning

confidence: 93%

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

Cleator¹,

Kasasbeh²

2016

J Cardiovasc Dis Diagn

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The goal for treatment of medical refractory Hypertrophic Obstructive Cardiomyopathy (HCM) is reduction of the hypertrophied left ventricular septum which obstructs blood flow. A surgical approach consists of an open-heart myomectomy, while the less invasive percutaneous approach involves creating a myocardial infarction by injecting 95 to 100% ethanol through a septal artery, a procedure termed alcohol septal ablation (ASA). Although less invasive than myomectomy, there are several limitations of alcohol septal ablation. The most important appears to be full thickness infarction that is often complicated by heart block and ventricular tachycardia/fibrillation. The ideal therapy for septal hypertrophy would be to find an agent that induces a less severe injury and/or atrophy of the hypertrophied septum. We review several alternative techniques for selective injury of the septum and describe the ideal characteristics of such an ideal agent. Our central hypothesis is that the anthracycline antibiotic such as doxorubicin may be the perfect agent. Anthracycline-based chemotherapies have been used in the treatment of solid and hematological tumors for many years. These agents have known cardiotoxic side effects that are related to cumulative dose which can lead to heart failure. Although the mechanism of action of doxorubicin cardiotoxicity is controversial, it is very clear that these agents cause atrophy of the myocardium, induce apoptosis and necrosis, as well as anti-angiogenic effects. We propose that selectively treating the hypertrophied septum of HCM patients with injection of the anthracycline doxorubicin will lead to superior outcomes compared to ASA.

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“…Kwon et al reported no intraprocedural mortality in patients at high surgical risk. 28 In the review by Alam et al, early (30-day) mortality was 1.5% (0.0---5.0%) and late mortality (>30 days) was 0.5% (0.0---9.3%).…”

Section: Safety and Complicationsmentioning

confidence: 98%

Alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Four years of experience at a reference center

Fiarresga

Cacela

Galrinho

et al. 2014

Revista Portuguesa de Cardiologia (English Edition)

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Introduction: We describe our center's initial experience with alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy. The procedure, its indications, results and clinical outcomes will be addressed, as will its current position compared to surgical myectomy. Objective: To assess the results of ASA in all patients treated in the first four years of activity at our center. Methods: We retrospectively studied all consecutive and unselected patients treated by ASA between January 2009 and February 2013. Results: In the first four years of experience 40 patients were treated in our center. In three patients (7.5%) the intervention was repeated. Procedural success was 84%. Minor complications occurred in 7.5%. Two patients received a permanent pacemaker for atrioventricular block (6% of those without previous pacemaker). The major complication rate was 5%. There were no in-hospital deaths; during clinical follow-up (22±14 months) cardiovascular mortality was 2.5% and overall mortality was 5%. Discussion and Conclusion:The results presented reflect the initial experience of our center with ASA. The success rate was high and in line with published results, but with room to improve with better patient selection. ASA was shown to be safe, with a low complication rate and no procedure-related mortality. Our experience confirms ASA as a percutaneous alternative to myectomy for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy refractory to medical treatment. PALAVRAS-CHAVE

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Long-Term Outcomes in High-Risk Symptomatic Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation

Cited by 75 publications

References 32 publications

Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

Alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Four years of experience at a reference center

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