Robbert C Steggerda1, Kevin Damman2, Jippe C Balt3, Max Liebregts3, Jurriën M ten Berg3, Maarten P van den Berg2. 1. Department of Cardiology, Martini Hospital, Groningen, the Netherlands. Electronic address: r.c.steggerda@mzh.nl. 2. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 3. Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Abstract
OBJECTIVES: This study compared alcohol septal ablation (ASA) and surgical myectomy for periprocedural complications and long-term clinical outcome in patients with symptomatic hypertrophic obstructive cardiomyopathy. BACKGROUND: Debate remains whether ASA is equally effective and safe compared with myectomy. METHODS: All procedures performed between 1981 and 2010 were evaluated for periprocedural complications and long-term clinical outcome. The primary endpoint was all-cause mortality; secondary endpoints consisted of annual cardiac mortality, New York Heart Association functional class, rehospitalization for heart failure, reintervention, cerebrovascular accident, and myocardial infarction. RESULTS: A total of 161 patients after ASA and 102 patients after myectomy were compared during a maximal follow-up period of 11 years. The periprocedural (30-day) complication frequency after ASA was lower compared with myectomy (14% vs. 27%, p = 0.006), and median duration of in-hospital stay was shorter (5 days [interquartle range (IQR): 4 to 6 days] vs. 9 days [IQR: 6 to 12 days], p < 0.001). After ASA, provoked gradients were higher compared with myectomy (19 [IQR: 10 to 42] vs. 10 [IQR: 7 to 13], p < 0.001). After multivariate analysis, age (per 5 years) (hazard ratio: 1.34 [95% confidence interval: 1.08 to 1.65], p = 0.007) was the only independent predictor for all-cause mortality. Annual cardiac mortality after ASA and myectomy was comparable (0.7% vs. 1.4%, p = 0.15). During follow-up, no significant differences were found in symptomatic status, rehospitalization for heart failure, reintervention, cerebrovascular accident, or myocardial infarction between both groups. CONCLUSIONS: Survival and clinical outcome were good and comparable after ASA and myectomy. More periprocedural complications and longer duration of hospital stay after myectomy were offset by higher gradients after ASA.
OBJECTIVES: This study compared alcohol septal ablation (ASA) and surgical myectomy for periprocedural complications and long-term clinical outcome in patients with symptomatic hypertrophic obstructive cardiomyopathy. BACKGROUND: Debate remains whether ASA is equally effective and safe compared with myectomy. METHODS: All procedures performed between 1981 and 2010 were evaluated for periprocedural complications and long-term clinical outcome. The primary endpoint was all-cause mortality; secondary endpoints consisted of annual cardiac mortality, New York Heart Association functional class, rehospitalization for heart failure, reintervention, cerebrovascular accident, and myocardial infarction. RESULTS: A total of 161 patients after ASA and 102 patients after myectomy were compared during a maximal follow-up period of 11 years. The periprocedural (30-day) complication frequency after ASA was lower compared with myectomy (14% vs. 27%, p = 0.006), and median duration of in-hospital stay was shorter (5 days [interquartle range (IQR): 4 to 6 days] vs. 9 days [IQR: 6 to 12 days], p < 0.001). After ASA, provoked gradients were higher compared with myectomy (19 [IQR: 10 to 42] vs. 10 [IQR: 7 to 13], p < 0.001). After multivariate analysis, age (per 5 years) (hazard ratio: 1.34 [95% confidence interval: 1.08 to 1.65], p = 0.007) was the only independent predictor for all-cause mortality. Annual cardiac mortality after ASA and myectomy was comparable (0.7% vs. 1.4%, p = 0.15). During follow-up, no significant differences were found in symptomatic status, rehospitalization for heart failure, reintervention, cerebrovascular accident, or myocardial infarction between both groups. CONCLUSIONS: Survival and clinical outcome were good and comparable after ASA and myectomy. More periprocedural complications and longer duration of hospital stay after myectomy were offset by higher gradients after ASA.
Authors: Josef Veselka; Lothar Faber; Max Liebregts; Robert Cooper; Jaroslav Januska; Jan Krejci; Thomas Bartel; Maciej Dabrowski; Peter Riis Hansen; Vibeke Marie Almaas; Hubert Seggewiss; Dieter Horstkotte; Radka Adlova; Henning Bundgaard; Jurriën Ten Berg; Rodney Hilton Stables; Morten Kvistholm Jensen Journal: J Am Heart Assoc Date: 2017-05-16 Impact factor: 5.501