Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience

Kuhn, H.; Lawrenz, Thorsten; Lieder, Frederick W. C.; Leuner, Christian; Strunk-Mueller, C.; Obergassel, Ludger; Bartelsmeier, Markus; Stellbrink, Christoph

doi:10.1007/s00392-007-0616-7

Cited by 119 publications

(102 citation statements)

References 29 publications

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“…In 2008 Kuhn et al published the results of 644 consecutive patients treated by ASA over a 10-year period. 36 Annual cardiac mortality after discharge was 0.7%, a similar percentage to the untreated population, which does not support the idea that these patients are at greater risk of sudden death. 37 The latest and largest meta-analysis of the two techniques analyzed 2207 patients treated by ASA and 1887 patients treated by myectomy and found no differences in overall mortality or sudden death, even though the population treated surgically were younger.…”

Section: Comparison With Myectomymentioning

confidence: 78%

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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Section: Comparison With Myectomymentioning

confidence: 78%

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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“…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: 87%

Section: Limitations Of Asamentioning

confidence: 91%

“…Large prospective registries, such as the German ASA registry, have shown major complications rates of 15.6%, a mortality rate of 1.2%, and a permanent pacemaker implantation rate of 9.6% [13]. 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].…”

Section: Limitations Of Asamentioning

confidence: 99%

“…Recent reports suggest that lethal arrhythmogenic events linked to ablation may not be uncommon [19,20]. In addition, alcohol septal ablation has also been associated with increased firing of implantable cardioverter defibrillators [13]. All these limitations suggest the need to think about other agents that might reduce septal hypertrophy via a percutaneous approach.…”

Section: Limitations Of Asamentioning

confidence: 99%

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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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Complications of low‐dose, echo‐guided alcohol septal ablation

Veselka

Zemánek

Tomašov

et al. 2009

Cathet Cardio Intervent

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Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience

Cited by 119 publications

References 29 publications

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

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

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

Complications of low‐dose, echo‐guided alcohol septal ablation

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