A meta analysis of current status of alcohol septal ablation and surgical myectomy for obstructive hypertrophic cardiomyopathy.

Abstract

Our objective was to perform an updated systematic review to compare the efficacy and short- and long-term mortality of surgical myectomy (SM) and alcohol septal ablation (ASA) by including most recent and largest cohort studies published in last few years. SM and ASA are the two invasive strategies used to relieve left ventricular outflow tract obstruction (LVOTO) in patients with drug refractory symptomatic hypertrophic cardiomyopathy (HCM). In the absence of a randomized trial, we tried to compare the pros and cons of the two procedures using a systematic review and meta-analysis. A comprehensive search of three major databases was performed. We included original research studies comparing data on ASA and SM. Of 1,143 citations, 10 studies were included in the analysis. A total of 805 patients underwent ASA and 1,019 underwent SM. Patients undergoing SM were younger (MD 6.3, P = 0.0001) and had higher reduction in the LVOT gradient (MD -9.56, P = 0.05). However, there was similar resolution of class III and IV symptoms between the two groups (P = 0.56). There was no difference in sudden cardiac death (SCD) (P = 0.93), short-term (P = 0.36), long-term all cause (P = 0.27), and long-term cardiac mortality (P = 0.58). Patients undergoing ASA had higher incidence of post procedure device implantation (OR 3.09, P < 0.00001). No significant difference in symptom relief was noted between the two approaches. ASA was as safe a myectomy with regards to SCD, short-term, and long-term mortality. © 2015 Wiley Periodicals, Inc.