Glue septal ablation: A promising alternative to alcohol septal ablation
Sercan Okutucu1, Kudret Aytemir2, Ali Oto1
1Memorial Ankara Hospital, Ankara, Turkey.
Insights
Glue septal ablation (GSA) offers a safe and effective alternative for treating obstructive hypertrophic cardiomyopathy (HOCM). This promising technique reduces left ventricular outflow tract obstruction and improves patient function, potentially avoiding complications associated with alcohol septal ablation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Hypertrophic cardiomyopathy (HCM) involves myocardial hypertrophy without other causes.
- Obstructive hypertrophic cardiomyopathy (HOCM) affects ~70% of HCM patients, causing left ventricular outflow tract obstruction (LVOTO).
- Treatment options for medically refractory HOCM include surgical septal myectomy and alcohol septal ablation (ASA), though ASA carries risks like heart block and myocardial necrosis.
Purpose of the Study:
- To evaluate the efficacy and safety of glue septal ablation (GSA) as a treatment for HOCM.
- To compare the properties of GSA with ASA, highlighting potential advantages of glue.
- To assess the impact of GSA on LVOT gradient, septal thickness, and functional capacity.
Main Methods:
- Retrospective analysis of patients with HOCM treated with GSA.
- Assessment of immediate and 12-month follow-up data including LVOT gradient, interventricular septal wall thickness, and New York Heart Association (NYHA) functional class.
- Comparison of GSA's properties with those of ASA, focusing on polymerization and contraindications.
Main Results:
- GSA effectively and safely reduced LVOT gradient immediately post-procedure, with sustained reduction at 12 months.
- The technique led to improvements in NYHA functional capacity.
- GSA resulted in a decrease in interventricular septal wall thickness.
- Glue's immediate polymerization prevents leakage into coronary arteries, a key advantage over alcohol, especially in patients with coronary collaterals.
Conclusions:
- GSA is an effective and safe alternative for HOCM treatment, demonstrating immediate and sustained reduction in LVOT gradient.
- The procedure improves functional capacity and reduces septal thickness in HOCM patients.
- Further research is warranted to establish the long-term efficacy and safety profile of GSA.
Abstract:
Hypertrophic cardiomyopathy (HCM) is defined as myocardial hypertrophy in the absence of another cardiac or systemic disease capable of producing the magnitude of present hypertrophy. In about 70% of patients with HCM, there is left ventricular outflow tract (LVOT) obstruction (LVOTO) and this is known as obstructive type of hypertrophic cardiomyopathy (HOCM). Cases refractory to medical treatment have had two options either surgical septal myectomy or alcohol septal ablation (ASA) to alleviate LVOT gradient. ASA may cause some life-threatening complications including conduction disturbances and complete heart block, hemodynamic compromise, ventricular arrhythmias, distant and massive myocardial necrosis. Glue septal ablation (GSA) is a promising technique for the treatment of HOCM. Glue seems to be superior to alcohol due to some intrinsic advantageous properties of glue such as immediate polymerization which prevents the leak into the left anterior descending coronary artery and it is particularly useful in patients with collaterals to the right coronary artery in whom alcohol ablation is contraindicated. In our experience, GSA is effective and also a safe technique without significant complications. GSA decreases LVOT gradient immediately after the procedure and this reduction persists during 12 months of follow-up. It improves New York Heart Association functional capacity and decrease interventricular septal wall thickness. Further studies are needed in order to assess the long-term efficacy and safety of this technique.
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