Journal Article

Extended septal myectomy versus alcohol septal ablation: clinical results at a national referral centre

Martínez-López, Daniel, Vera-Puente, Beatriz, Villar García, Susana, Forteza-Gil, Alberto, García-Pavía, Pablo, Cavero, Miguel Ángel, Ríos-Rosado, Elsa Carolina, García Suárez, Jessica, Olivo-Soto, Jean Carlo, Martín-López, Carlos Esteban, Oteo-Domínguez, Juan Francisco, de Villarreal-Soto, Juan Esteban, Arízaga-Arce, Fernando, Ospina Mosquera, Víctor Manuel

2024

Overview

OBJECTIVES Extended septal myectomy and alcohol septal ablation are 2 invasive treatments for hypertrophic obstructive cardiomyopathy. Our goal was to compare which of these techniques achieved a higher reduction in gradients, improvement in New York Heart Association (NYHA) functional class and reduction in medical treatment. METHODS It is a single-centre observational and retrospective analysis. We used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. The odds ratio or coefficient along with the 95% confidence interval was estimated according to the group and adjusted for the corresponding preprocedural variables and EuroSCORE II. RESULTS A total of 78 patients underwent septal myectomy, and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced to a higher degree in comparison to ablation: 21.0 mmHg [P < 0.001, 95% confidence interval -30.7; -11.3], and 34.3 mmHg (P < 0.001, -49.1; -19.5) respectively. Those patients who received a myectomy had a lower probability of having moderate mitral regurgitation (odds ratio = 0.18, P = 0.054). Patients after septal myectomy were more likely to be NYHA functional class I (80.4%), whereas patients after ablation were more likely to be NYHA functional class III (48%). Both groups continued with beta-blocker therapy, but disopyramide could be discontinued after the myectomy in more cases (20%–36% vs 59%–1.3%; P < 0.001), and there was a tendency to discontinue calcium channel blockers (48%–16% vs 15.4–3.8%; P = 0.054). CONCLUSIONS After adjustment using preprocedural gradients and EuroSCORE II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation. Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic and familiar disease with an incidence that oscillates between 0.2% and 0.5% [1–2]. Graphical Abstract

• Publisher: Oxford University Press,Oxford Publishing Limited (England)
• Subject: Ablation / Alcohol / Heart Failure