Clinical comparison of the two invasive treatments of hypertrophic obstructive cardiomyopathy: a systematic review and meta-analysis

Abstract

Abstract Background The two available interventional treatment of patients with hypertrophic obstructive cardiomyopathy aresurgical myectomy (SM) and Alcohol septal ablation (ASA). The aim of this meta-analysis was to assess the efficacity of these two invasive strategies in relieving symptoms and left ventricular outflow tract obstruction (LVOTO). Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until February 2020 for RCTs and cohorts comparing clinical outcomes with alcohol septal ablation (ASA) vs surgical myectomy (SM) in patients with HCM. The endpoints were relieving symptoms, reduced left ventricular outflow tract obstruction (LVOTO) and the need for reintervention. Results We included 20 studies (n=4547; 3 RCTs and 17 cohorts) comparing ASA vs MS for a mean follow-up 5.2±2.1 year. Baseline mean LVOT gradient was not different between the ASA and the MS patient groups with weighted mean difference (WMD) = 1.50 [−3.47 to 6.46, p=0.56]. During follow-up, SM patients showed greater reduction in the LVOT gradient compared to ASA WMD = −9.61 [CI, 4.71 to 14.50, p=0.0001]. In addition, SM group had greater resolution of clinical symptoms compared to ASA (NYHA class III/IV, 17% vs. 6.2% R: 2.76, CI, 1.64 to 4.64, p<0.001, angina 46% vs. 15.7%, RR: 2.79 [CI, 1.14 to 6.82, p=0.02) and lower reinterventions (10.1% vs. 0.02%; RR=15.1, 95% CI: 6.10 to 37.1 p<0.001). Conclusion Compared with alcohol septal ablation, septal myectomy treatment of hypertrophic obstructive cardiomyopathy is associated with greater resolution of clinical symptoms and less need for reintervention. Funding Acknowledgement Type of funding source: None