Prevalence of Non–Left Anterior Descending Septal Perforator Culprit in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation

Alkhouli, Mohamad; Sajjad, Waseem; Lee, Junsoo; Fernandez, Genaro; Waits, Bryan; Schwarz, Karl Q.; Cove, Christopher J.

doi:10.1016/j.amjcard.2016.02.046

Cited by 12 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 In addition, there are now emerging data on the optimal ASA techniques and their associated learning curve confirming the increasing interest in this procedure. 4,[54][55][56] One meta-analysis comparing long-term outcomes of SM and ASA (24 studies including 4804 patients) has previously been published. 8 In this analysis, Liebregts et al found similar long-term rates of mortality and SCD in patients undergoing SM or ASA.…”

Section: Discussionmentioning

confidence: 99%

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta‐analysis

Kheiri

Osman

Barbarawi

et al. 2018

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Background: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are effective therapies for patients with hypertrophic cardiomyopathy who remain symptomatic despite medical therapy. A plethora of data has recently emerged on the long-term outcomes of these procedures.We hence sought to perform an updated meta-analysis comparing both procedures.Methods: Studies reporting long-term (>3-years) outcomes of SM and/or ASA were included.The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, sudden cardiac death (SCD), reintervention, and complications including death, pacemaker implantation, and stroke.Results: Twenty-two ASA cohorts (n = 4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up = 6.8-years) were included. Septal myectomy was associated with higher periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs 0.8% P = 0.013, respectively), but ASA was associated with more need of pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause mortality, cardiovascular mortality, and sudden cardiac death rates were 1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and 0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43), respectively. Repeat septal reduction intervention(s) were more common after ASA (11% vs 1.5%, P < 0.001). Conclusion:Compared with SM, ASA is associated with lower periprocedural mortality and stroke but higher rates of pacemaker implantations and reintervention. However, there was no difference between ASA and SM with regards to long-term all-cause mortality, cardiovascular mortality, or SCD.

show abstract

Section: Discussionmentioning

confidence: 99%

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta‐analysis

Kheiri

Osman

Barbarawi

et al. 2018

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a recent study, 15% of patients undergoing ASA had a non-LAD septal perforator target artery for the ASA. Failing to identify this characteristic can account for a proportion of failed ASA procedures; and in fact, half of those patients will have had a previously failed ASA procedure (27).…”

Section: Coronary Anatomymentioning

confidence: 99%

Septal myectomy after failed septal alcohol ablation

Bajona

Arguís

Prat‐González

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Despite septal myectomy remaining the gold standard septal reduction therapy for hypertrophic obstructive cardiomyopathy (HOCM), there has been a disproportionate use of alcohol septal ablation (ASA) worldwide.Absolute resolution of left ventricular outflow tract (LVOT) obstruction with ASA is not achieved in a substantial proportion of patients. The mechanisms of failure from ASA are partially understood and described. Residual obstruction in hypertrophic cardiomyopathy is associated with worse clinical outcomes and mortality. There is a growing number of patients who present with significant residual gradients after ASA and require a rescue septal myectomy operation, which then carries an increased risk of perioperative complications and life-long sequelae. This contrasts with the excellent outcomes achieved by septal myectomy without previous percutaneous intervention. Despite complete resolution of obstruction in rescue myectomy, the outcomes remain compromised by the prior ASA.

show abstract

“…A previous study on PTSMA through non-LAD septal perforators also reported that a significant number of patients had undergone at least one previous unsuccessful PTSMA, and mentioned the importance of systematic screening for the ideal target septal branch to avoid incomplete PTSMA [22]. There are several key points that can be learned from this case review.…”

Section: Discussionmentioning

confidence: 70%

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy through non-left anterior descending septal perforators

et al. 2019

View full text Add to dashboard Cite

Percutaneous transluminal septal myocardial ablation (PTSMA) has become a significant treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) despite maximal medical therapy. The target septal arteries usually arise from the left anterior descending artery (LAD). However, when septal perforators do not originate from the LAD, non-LAD septal perforators should be included as candidate-target septal branches that feed the hypertrophic septal myocardium, causing left ventricular outflow tract (LVOT) obstruction. Data pertaining to the procedure remain limited. We aimed to investigate PTSMA through the non-LAD septal perforators in patients with HOCM. In this case series review, we evaluated the baseline characteristics, echocardiographic features, and angiographic features, as well as symptoms and pressure gradient before and after PTSMA through the non-LAD septal perforators. Among 202 consecutive patients who underwent PTSMA for HOCM with LVOT obstruction, 21 had non-LAD septal branches that fed the hypertrophic septal myocardium and received alcohol ablation. Non-LAD septal perforators could be used as an alternative route for PTSMA in patients who experienced ineffective ablation of the septal branch that arises from the LAD. This unique procedure may improve response rates and overall outcomes of patients with HOCM.

show abstract

Prevalence of Non–Left Anterior Descending Septal Perforator Culprit in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation

Cited by 12 publications

References 8 publications

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta‐analysis

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta‐analysis

Septal myectomy after failed septal alcohol ablation

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy through non-left anterior descending septal perforators

Contact Info

Product

Resources

About