Alcohol Septal Ablation In Patients Research Articles

Is unsatisfactory outcome of alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy predictable?

Abstract Background Alcohol septal ablation (ASA) has been introduced for left ventricular outflow tract gradient (LVOTG) reduction in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, some patients may not profit from ASA. Thus, we identified characteristics of patients with unsatisfactory outcome of ASA in a large single-center cohort. Methods Consecutive ASAs between 1997 and 2023, performed at our institution, were retrospectively enrolled. Those ASAs performed in patients with missing follow-up (FU), previous septal reduction therapy (SRT), and atypical HOCM were excluded. Patients with unsatisfactory outcome (PUO) were defined as continuing to meet the guideline criteria for SRT (NYHA ≥III or NYHA ≥II with exertional syncope and resting/exercise-induced LVOTG ≥50mmHg). PUO were compared to patients with good outcome (PGO). Results are expressed in % or median and interquartile range (IQR). Pre-procedural predictors of poor hemodynamic outcome were identified using logistic regression analysis. Results 65 of 1003 patients were PUO (6.5%). Those were younger (48.0 years [40.5-61.8] vs. 57.0 years [IQR 47.0-67.0] in PGO; p=0.0030), more often reported syncope at baseline (35.4% vs. 22.2% in PGO; p=0.0214), and had lower body-mass-index (26.4kg/m2 [23.8-29.2] vs. 27.7kg/m2 [25.2-23.1] in PGO; p=0.0160). In PUO, resting LVOTG was higher at baseline (53.0mmHg [24.5-82.0]) than in PGO (40.0mmHg [22.0-75.0]; p=0.0292; Table 1). Differences in sex, family history of sudden cardiac death, dyspnoea, medication, and interventricular septum diameter (IVSD) were not observed at baseline (all p>0.05; Table 1). Age (OR 1.023; CI: 1.005-1.042; p=0.0129), syncope at baseline (OR 1.890; CI: 1.049-3.324; p=0.0296), and BMI (OR 1.072; CI: 1.007-1.145; p=0.0355) were found to independently influence poor hemodynamic response to ASA using multiple logistic regression controlling for confounders. However, sex, baseline IVSD, and LVOTG were not found to influence poor hemodynamic outcome (p>0.05). There were no differences with regard to the number of embolized branches (1 in both groups), the size of the balloon used to cover the septal branch (1.5mm in both groups), the volume of ethanol (PUO: 1.4ml [1.0-2.0]; PGO: 1.5ml [1.2-2.0]), or creatine kinase release (PUO: 879.0U/l [375.0-1187.0]; PGO: 842.0U/l [501.5 - 1234]) (all p>0.05). At 6-months-FU, PUO had significantly higher IVSD (18.0mm [13.5-22.0] vs. 16.0mm [12.0-19.0] in PGO; p=0.008), higher resting LVOTG (31.0mmHg [20.0-55.5] vs. 14.0mmHg [10.0-22.0] in PGO; p<0.0001) and higher exercise-induced LVOTG (105.0mmHg [84.5-143.0] vs. 35.0mmHg [22.0-64.0] in PGO; p<0.0001). Conclusion ASA was overall effective with only few patients experiencing unsatisfactory outcome. Syncope, age, and BMI were found predicting poor hemodynamic outcome.Baseline characteristics

Mortality After Alcohol Septal Ablation vs. Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy.

Background: Alcohol septal ablation (ASA) and septal myectomy (SM) are 2 options for septal reduction therapy (SRT) to treat medication-resistant symptomatic obstructive hypertrophic cardiomyopathy (HCM). Because differences in mortality rates after these different SRT methods have not been extensively investigated in real-world settings, in this study compared the 1-year mortality rates after ASA and SM using population-based database. Methods and Results: Utilizing New York Statewide Planning and Research Cooperative System (SPARCS) data from 2005 to 2016, we performed a comparative effectiveness study of ASA vs. SM in patients with HCM. The outcome was all-cause death up to 360 days after SRT. We constructed a multivariable logistic regression model and performed sensitivity analysis with propensity score (PS)-matching and inverse probability of treatment weighting (IPTW) methods. We identified 755 patients with HCM who underwent SRT: 348 with ASA and 407 with SM. The multivariable analysis showed that all-cause deaths were significantly fewer in the ASA group at 360 days after SRT (adjusted odds ratio=0.34; 95% confidence interval [CI] 0.13-0.84; P=0.02). The PS-matching and IPTW methods also supported a lower mortality rate in the ASA group at 360 days post-SRT. Conclusions: In this population-based study of patients with HCM who underwent SRT in a real-world setting, the 1-year all-cause mortality rate was significantly lower in patients who underwent ASA compared with SM.

Outcomes of Alcohol Septal Ablation in Patients With Severe Left Ventricular Outflow Tract Obstruction: A Propensity Score Matching Analysis.

The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg. We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO. A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P= 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P= 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P= 0.02). After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.

Alcohol septal ablation in patients aged 75 years or older with hypertrophic obstructive cardiomyopathy

ObjectiveOutcome data for patients ≥75 years with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA) are lacking. Therefore, a retrospective single-centre analysis was conducted.MethodsThe data of all consecutive ASAs,...

Relationship between mitral valve echocardiographic parameters and interventional septal reduction therapy success in patients with hypertrophic obstructive cardiomyopathy - a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background The mitral valve (MV) has an important contribution to left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Several parameters were described to be significantly different between obstructive and non-obstructive forms of HCM, like the aortomitral angle, anterior mitral leaflet (AML) and LVOT size, anterior displacement of the coaptation line, annular related parameters, etc. The redundant length of the AML beyond the coaptation point and the entire AML length are important in the decision to also approach the mitral valve when surgical septal reduction therapy (SRT) is considered, to increase the success rate. Data is scarce regarding mitral valve related predictors of interventional SRT response. This is important as certain patients have a suboptimal response regardless of the proper coronary anatomy and branch targeting. Purpose To evaluate the possible differences in certain mitral valve parameters in interventional SRT responders versus non-responders. Methods We retrospectively included in the study a number of 21 consecutive HOCM patients treated with alcohol septal ablation (ASA). All the procedures were guided with contrast echocardiography besides fluoroscopy and all patients had a proper distribution of at least 1 septal branch. They were divided in two groups- responder group (15 patients) with a non-significant residual LVOT PG (&amp;lt;50mmHg/&amp;gt;50% reduction) and non-responder group (6 patients) with a significant residual LVOT PG (&amp;gt;50mmHg/&amp;lt;50% reduction) and/or early rebound. We accounted for the residual LVOT PG evaluated by continuous Doppler at least 6 months after SRT. The groups were compared regarding LV dimensions and ejection fraction and mitral valve annulus/ leaflet size and displacement of the coaptation line, evaluated by bidimensional transthoracic echocardiography, before the intervention. Results The most hypertrophied part of the LV was the basal interventricular septum (IVS). The two groups were similar regarding age, comorbidities, LV dimensions and ejection fraction and baseline LVOT PG. Also, there was no significant difference between AML length, posterior mitral leaflet (PML) length, AML/PML, MV annulus. The redundant length of the AML was significantly lower in responders whereas anterior displacement of the coaptation point (projection of AML/projection of PML on the MV annulus) was less intense in responders and almost reached statistical significance. (Table) Interestingly, we found a baseline AML/PML projection &amp;lt;1 in all non-responder patients and only in 2 responder patients (13.33%) (p&amp;lt;0.001). Conclusion So far, significant anterior displacement of the coaptation point and the residual AML length may have an important impact on the response to ASA in HOCM patients. This pilot study could be an important start point for larger prospective studies to confirm and evaluated the prediction value of these parameters among others.

Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective.

Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient's hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients-the Cardiomyopathy Team.

Alcohol septal ablation versus surgical septal myectomy of obstructive hypertrophic cardiomyopathy: systematic review and meta-analysis.

To elucidate the optimal septal reduction therapy for obstructive hypertrophic cardiomyopathy, we conducted a meta-analysis comparing alcohol septal ablation (ASA) and septal myectomy. MEDLINE, EMBASE and Cochrane CENTRAL were searched to identify studies investigating the outcomes of ASA and septal myectomy in patients with obstructive hypertrophic cardiomyopathy in January 2023. The primary outcome of interest was all-cause mortality in studies with ≥1 year of follow-up. The secondary outcomes of interest comprised left ventricular outflow tract (LVOT) pressure gradient reduction and reoperations of LVOT. A subgroup analysis of all-cause mortality including studies with follow-up ≥5 years was performed. 27 observational studies were included (15 968 patients). Analysis demonstrated similar all-cause mortality [hazard ratio (HR) (95% confidence interval) (CI) 1.24 (0.88-1.76); P = 0.21; I2 = 56%]. In contrast, ASA was associated with less reduction of LVOT pressure gradient and a reoperation rate [weighted mean difference (95% CI) 11.04 mmHg (5.60-16.48); P < 0.01; I2 = 64%, HR (95% CI) 9.14 (6.55-12.75); P < 0.001; I2 = 0%, respectively]. The subgroup analysis with follow-up ≥5 years revealed higher long-term mortality with ASA [HR (95% CI) 1.50 (1.04-2.15); P = 0.03; I2 = 52%]. Although both septal reduction therapies were associated with similar all-cause mortality, ASA was associated with a higher rate of reoperation and less reduction of LVOT pressure gradient. Furthermore, all-cause mortality with follow-up ≥5 years showed favourable outcomes with septal myectomy, although the result is only hypothesis-generating given a subgroup analysis.

Abstract 11462: Alcohol Septal Ablation vs Surgical Myectomy for Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Introduction: Surgical Myectomy (SM) is the gold standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). However, alcohol septal ablation (ASA) has emerged as an alternative option for selected patients. Nonetheless, the long-term efficacy and safety of ASA have been debated in recent years. The aim of this metanalysis is to evaluate the long-term outcomes of ASA vs SM in HOCM patients. Hypothesis: ASA is a safe and effective alternative to SM in HOCM. Methods: : Unrestricted searches of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2022, for studies comparing long-term outcomes of ASA with SM in HOCM patients. Relevant data were extracted and analyzed using Revman 5.3 software. Odds Ratio (OR) and 95% Confidence interval (CI) were calculated using the random-effects model. Results: : A total of 12 retrospective studies were included examining 7,599 HOCM patients (2,010 ASA vs 5,589 SM). After a mean follow-up of 5.04 years, all-cause mortality was similar between the two groups (OR 1.18; 95% CI 0.60-2.29). However, ASA was associated with high rates of reinterventions (OR 15.68; 95% CI 6.71-36.61), and pacemaker insertion (OR 2.74; 95% CI 1.39-5.41). Conclusions: Although there was no difference in mortality between ASA and SM, ASA was associated with higher rates of reinterventions and pacemaker insertion in long-term follow-up. Therefore, the selection of septal reduction therapy in HOCM should be individualized and should be performed in a comprehensive center after detailed risk and benefits discussions with an experienced team.

Safety and Outcomes of Alcohol Septal Ablation Prior to Transcatheter Mitral Valve Replacement.

Patients undergoing transcatheter mitral valve replacement (TMVR) for mitral valve disease caused by severe mitral annular calcification are at risk of left ventricular outflow obstruction. Preemptive alcohol septal ablation (ASA) can potentially mitigate the risk of this complication and is well established in patients with hypertrophic obstructive cardiomyopathy (HCM). This retrospective study compared procedural characteristics and outcomes in patients who underwent ASA for TMVR vs HCM. In total, 102 patients were included, 22 in the TMVR group and 80 in the HCM group. Echocardiography demonstrated increased septal wall thickness in the HCM group (19​±​3.1​mm vs 12.7​±​2.0​mm; P​<​.001). The mean volume of ethanol injected was higher in the HCM group (1.4​±​0.49​mL vs 0.8​±​0.2​mL; P​<​.001). The average neo-left ventricular outflow tract area increased significantly after ASA in the patients undergoing TMVR (135​±​89​mm2 vs 233​±​111​mm2; P​<​.001). Six patients in the TMVR group did not achieve an adequate increase in the neo-left ventricular outflow tract area and required further procedures after ASA. The incidence of post-ASA complete heart block requiring a permanent pacemaker tended to be higher in the TMVR group (35% vs 21%; P​=​.195). No patients in either group had ventricular arrhythmia or stroke. Major bleeding complications were 4% in the HCM group and 0 in the TMVR group. The 30-day mortality was 4% in the HCM group and 0 in the TMVR group; however, 1 patient died at 37​days in the TMVR group, presumably from late heart block. Preemptive ASA in patients undergoing TMVR demonstrated safety and short-term clinical outcomes similar to patients with HCM.

TCT-356 Long-Term Follow-Up Post Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy

TCT-356 Long-Term Follow-Up Post Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy

Preoperative myocardial fibrosis is associated with worse survival after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: A delayed enhanced cardiac magnetic resonance study

BackgroundPrior studies have shown that myocardial fibrosis can be detected by late gadolinium enhancement (LGE) of cardiac magnetic resonance (CMR) and might be associated with higher mortality risk in hypertrophic cardiomyopathy (HCM). The objective of this study was to examine the prognostic utility of CMR in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA).Materials and methodsWe conducted a retrospective study which consisted of 183 consecutive patients with symptomatic drug-refractory HOCM who underwent CMR for assessment of myocardial fibrosis before ASA. The cardiovascular disease related survival was evaluated according to LGE-CMR status.ResultsThe cohort comprised 74 (40.4%) women with a mean age of 51 ± 8 years. Preoperative myocardial fibrosis was detected in 148 (80.9%) patients. After a median of 6 years (range 2–11 years) follow-up, adverse clinical events occurred in 14 (7.7%) patients. Multivariate-adjusted Cox regression analyses revealed that age [hazard ratio (HR) 1.142 (1.059–1.230), p = 0.001] and LGE [HR 1.170 (1.074–1.275), p < 0.001] were independent predictors of cardiovascular mortality during follow-up.ConclusionPreoperative myocardial fibrosis measured by LGE-CMR was an independent predictor of increased adverse clinical outcomes in patients with HOCM undergoing ASA and could be used for the pre-operative evaluation of risk stratification and long-term prognosis after ASA in these patients.

Periprocedural, Short-Term, and Long-Term Outcomes of Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A 20-Year Single-Center Experience.

Background: Alcohol septal ablation is recommended for hypertrophic obstructive cardiomyopathy patients who had refractory symptoms despite optimal medical treatment. We compared the periprocedural, short-, and long-term clinical outcomes and mortality predictors in hypertrophic obstructive cardiomyopathy patients who underwent alcohol septal ablation.MethodsHypertrophic obstructive cardiomyopathy patients aged ≥18 years (63 females and 71 males) who underwent alcohol septal ablation were included. The primary endpoint was all-cause mortality.ResultsThe mean patient age was 60.0 (standard deviation 13.7) years. The median follow-up time was 13 (7.6-18.5) years. During the procedure, 9, 2, and 1 patients developed ventricular fibrillation, remote site myocardial infarction, and pericardial tamponade, respectively, but none died. One patient died during hospitalization. During the long-term follow-up, 17, 5, 20, and 8 patients developed heart failure, myocardial infarction, chronic atrial fibrillation, and non-fatal stroke, respectively, and 24 died. There was no significant difference between the sexes (all P > .05). Age (hazard ratio = 0.69, 95% CI = 0.61‒0.78, P < .001), body mass index (hazard ratio = 1.20, 95% CI = 1.04-1.40, P = .01), age at diagnosis (hazard ratio = 1.57, 95% CI = 1.34-1.78, P < .001), and time from diagnosis to ablation (hazard ratio = 1.57, 95% CI = 1.35-1.84, P < .001) predicted all-cause mortality. In Kaplan‒Meier curves, long-term all-cause mortality was similar in men and women (P[log-rank] = .43).Conclusion Alcohol septal ablation has similar short- and long-term outcomes for both sexes in hypertrophic obstructive cardiomyopathy patients. Risk factors for long-term mortality were age, body mass index, diagnosis age, and time delay to operation. Therefore, alcohol septal ablation timing is essential for better clinical outcomes. Our findings may contribute to the increased performance of alcohol septal ablation in hypertrophic obstructive cardiomyopathy patients in our country.

Abstract 10792: Immediate Reduction in Left Ventricular End-Diastolic Pressure During Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Introduction: Alcohol septal ablation (ASA) is an elective nonsurgical procedure proven to be effective for patients with hypertrophic obstructive cardiomyopathy (HOCM). The intraprocedural change in left ventricular end-diastolic pressure (LVEDP) is unknown. In this study we assessed the hypothesis that LVEDP decreases immediately post ablation during ASA in patients with HOCM independently of the effects of sedation and heart rate. Methods: We retrospectively identified 133 elective ASA procedures for patients with HOCM between 2015 and 2021 at our institution using an internally maintained database. Pre- and post-ablation LVEDP measurements were taken using the pressure tracing corresponding with end-expiratory R wave of the ECG tracing. LVEDP was recorded for post-“a” wave points on the pressure tracing at three distinct points during the procedure: the immediate start of the procedure (Group A), prior to alcohol injection after sedation had taken effect (Group B), and post ablation (Group C). Heart rate (HR) and left ventricular outflow tract gradient (LVOTG) were obtained from the catheterization report. Paired t-tests, ANOVA, and regression analyses were performed using SPSS Statistics. Results: The average patient age was 64 years old; mean NYHA Class 2.7; and 67% were women. There was no difference between LVEDP of Groups A and B (32mmHg, 32mmHg, p=0.92). LVEDP between Groups A and C (32mmHg, 26mmHg, respectively; p&lt;0.001) and Groups B and C (32mmHg, 26mmHg, respectively; p&lt;0.001) were significantly different. There was no correlation between HR and LVEDP for the groups (R2A=0.002, R2B=0.000, R2C=0.054), and similarly, no correlation between the average change in LVEDP and the change in resting or provoked LVOTG (R2=0.033, R2=0.003, respectively). Conclusions: These results support that alcohol septal ablation causes an immediate reduction in LVEDP post-ablation independent of heart rate, reduction in LVOTG, and effects of sedation. In conclusion, this instantaneous change in LVEDP may account for the immediate resolution in symptoms reported by patients with HOCM undergoing ASA.

TCT-132 Short- and Long-Term Performance of Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy

TCT-132 Short- and Long-Term Performance of Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy

TCT-431 Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy: 17-Year Experience in Chile

TCT-431 Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy: 17-Year Experience in Chile

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography.

Background: Myocardial contrast two-dimensional echocardiography (MC-2DE) is widely used to address alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy (HCM). Owing to its limited cut-planes, MC-2DE may inaccurately identify the contrast misplacement associated with an unsuccessful or complicated ASA outcome. Objective: The aim of this study was to assess the added value of myocardial contrast three-dimensional echocardiography (MC-3DE) compared with MC-2DE to identify the appropriate matching between the target septal zone (TSZ) and coronary artery branch for safe and long-term effective ASA in HCM patients. Methods: A consecutive series of 52 symptomatic obstructive HCM patients referred for isolated surgical myectomy (SM) was analyzed with MC-2DE and MC-3DE following injection of echocontrast into one or more septal branches. MC-2DE and MC-3DE patterns were categorized according to complete (Type 1) or incomplete (Type 2) TSZ covering, high-risk (Type 3) exceeding TSZ, or life-threatening outside TSZ distribution (Type 4). Results: MC-2DE per patient analysis showed a Type 1 pattern in 32 patients and Types 2–4 in the remaining 20 patients; subsequent MC-3DE analysis provided a re-phenotyping of MC-2DE findings in 22 of the 52 patients (42%), showing a high-risk Type 2 pattern in 17 of the 32 patients with Type 1, and a new life-threatening Type 4 in three patients with Type 2, respectively. All patients with MC-3DE Type 1 pattern underwent safe and effective ASA with a long-term uneventful follow-up, while the remaining patients underwent SM. Conclusions: Refining high risk or life-threatening contrast misplacement, MC-3DE is more accurate than conventional MC-2DE to target safe and long-term effective septal reduction with ASA in obstructive HCM patients referred for isolated SM.

Myectomy versus alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy.

There is very little evidence comparing the safety and efficacy of alcohol septal ablation versus septal myectomy for a septal reduction in patients with hypertrophic obstructive cardiomyopathy. This study aimed to compare the immediate and long-term outcomes of these procedures. Following propensity score matching, we retrospectively analysed outcomes in 105 patients who underwent myectomy and 105 who underwent septal ablation between 2011 and 2017 at 2 reference centres. The mean age was 51.9 ± 14.3 and 52.2 ± 14.3 years in the myectomy and ablation groups, respectively (P = 0.855), and postoperative left ventricular outflow tract gradients were 13 (10-19) mmHg vs 16 (12-26) mmHg; P = 0.025. The 1-year prevalence of the New York Heart Association class III-IV was higher in the ablation group (none vs 6.4%; P = 0.041). The 5-year overall survival rate [96.8% (86.3-99.3) after myectomy and 93.5% (85.9-97.1) after ablation; P = 0.103] and cumulative incidence of sudden cardiac death [0% and 1.9% (0.5-7.5), respectively P = 0.797] did not differ between the groups. The cumulative reoperation rate within 5 years was lower after myectomy than after ablation [2.0% (0.5-7.6) vs 14.6% (8.6-24.1); P = 0.003]. Ablation was associated with a higher reoperation risk (subdistributional hazard ratio = 5.9; 95% confidence interval 1.3-26.3, P = 0.020). At follow-up, left ventricular outflow tract gradient [16 (11-20) vs 23 (15-59) mmHg; P < 0.001] and prevalence of 2+ mitral regurgitation (1.1% vs 10.6%; P = 0.016) were lower after myectomy than after ablation. Both procedures improved functional capacity; however, myectomy better-resolved classes III-IV of heart failure. Septal ablation was associated with higher reoperation rates. Myectomy demonstrated benefits in gradient relief and mitral regurgitation elimination. The results suggest that decreasing rates of myectomy procedures need to be investigated and reconsidered.

Ten Tips and Tricks for Performing Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Alcohol septal ablation (ASA) is an effective interventional therapeutic strategy to reduce or eliminate left ventricular outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM). Although ASA was introduced 25 years ago, there are still no available guidelines to follow. Therefore, most interventional cardiologists rely on their own experience, which is often limited by a relatively low number of performed procedures. This paper presents ten tips and tricks to safe and effective ASA for HOCM.

Outcomes of hypertrophic obstructive cardiomyopathy patients undergoing alcohol septal ablation with a standard 3 mL dose of ethanol: Focus on long-term safety.

The objective of this research was to assess the long-term results of alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy (HOCM), with all of them receiving a standard 3 mL ethanol dose. Generally, ethanol (0.5-3 mL) is infused depending on a septal artery width or interventricular septum (IVS) thickness during alcohol septal ablation. We injected 3 mL of ethanol irrespective of IVS thickness or perforator width in all cases. Between 2000 and 2017, 150 HOCM patients (78 males, 72 females) underwent alcohol septal ablation procedures. In all cases we intentionally used the constant dose of ethanol (3 mL). The median of age was 52 (interquartile range: 41-60) years. The median of follow-up was 71 (interquartile range: 36-110) months. Hospital mortality was 0.67% (one patient died of sepsis). Perioperative high-grade atrioventricular blocks required permanent pacemaker implantations-18 (12%). Long-term survival rates were as follows: 95.1% (95% confidence interval [CI]: 92.7-97.5%), 85.8% (95% CI: 83.7-87.0%), and 81.7% (95% CI: 79.7-83.7%) at 5-, 10-, and 15-year follow-up, respectively. One-sample log-rank test revealed no significant differences in 15-year survival rates between the alcohol septal ablation cohort and age- and sex-matched Russian population. Alcohol septal ablation with the standard (3 mL) ethanol dose is safe and efficient. Survival rates after alcohol septal ablation are comparable with those in age- and sex-matched general Russian population.

TCT-131 Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy Leads to Sustained Long-Term Benefits: A Single Center Experience

TCT-131 Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy Leads to Sustained Long-Term Benefits: A Single Center Experience