Percutaneous transluminal septal myocardial ablation versus septal myectomy for treatment of patients with hypertrophic obstructive cardiomyopathy: a Meta-analysis

Abstract

Objective To evaluate the efficacy of percutaneous transluminal septal myocardial ablation (PTSMA) and septal myectomy (SM) for treatment of hypertrophic obstructive cardiomyopathy. Methods We searched all clinical controlled trials of PTSMA and SM in treatment of hypertrophic obstructive cardiomyopathy in Cochrane Library, PubMed, Web of Science, Wanfang Database and CNKI update to August, 2012. The selected studies in Chinese and English were used for Meta-analysis with software RevMan 5.0. Results Five studies including 286 cases (PTSMA:149, SM:137) were included in the study. Left ventricular outflow tract pressure was significantly reduced by SM treatment compared with PTSMA (OR=9.07, 95%CI: 0.96-17.18, P=0.030). There were no significant differences in interventricular septum thickness (OR=1.15, 95%CI: -0.79-3.10, P=0.240), left atrial diameter (OR=1.95, 95%CI: -0.16-4.07, P=0.070), left ventricular end-diastolic (OR=0.70, 95%CI: -0.79-2.19, P=0.360), end systolic diameter (OR=1.14, 95%CI: -1.65-3.93, P=0.420), degree of symptom improvement (chest pain: OR=1.07, 95%CI: 0.35-3.23, P=0.910; syncope: OR=0.32, 95%CI: 0.08-1.23, P=0.100), and postoperative mortality (OR=1.63, 95%CI: 0.46-5.76, P=0.450) between PTSMA and SM treatment; but the rates of pacemaker implantation (OR=5.91, 95%CI: 2.04-17.11, P=0.001) and reintervention treatment (OR=6.62, 95%CI: 1.20-36.62, P=0.030) in patients with PTMSA were significantly higher than those with SM. Conclusions There is no evidence to indicate that PTSMA can completely replace SM, as an alternative choice the therapy can be used according to left ventricular out flow tract pressure, symptoms, anatomy of target vessel and other conditions. Key words: Cardiomyopathy, hypertrophic; Therapy; Meta-analysis