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Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy: A propensity

Anita Nguyen1, Hartzell V Schaff1, Dustin Hang1

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.

The Journal of Thoracic and Cardiovascular Surgery
|October 4, 2018
PubMed

Insights

Surgical septal myectomy is superior to alcohol septal ablation for hypertrophic cardiomyopathy, offering better long-term reduction of left ventricular outflow tract obstruction and lower reintervention rates, though survival is similar.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Hypertrophic cardiomyopathy (HCM) can cause left ventricular outflow tract (LVOT) obstruction.
  • Surgical septal myectomy and alcohol septal ablation are primary treatments for obstructive HCM.
  • Comparative long-term effectiveness of alcohol septal ablation remains uncertain.

Purpose of the Study:

  • To compare short- and long-term outcomes of surgical septal myectomy versus alcohol septal ablation for obstructive HCM.
  • Evaluate procedural effectiveness in reducing LVOT gradients.
  • Assess differences in survival and need for reintervention.

Main Methods:

  • Retrospective study of 2407 patients undergoing septal myectomy and 211 undergoing alcohol septal ablation (December 1998 - September 2016).
  • 2:1 propensity score matching created a cohort of 334 myectomy patients and 167 alcohol ablation patients.
  • Outcomes analyzed included LVOT gradient reduction, survival, and reintervention rates.

Main Results:

  • Septal myectomy resulted in a significantly lower resting LVOT gradient (0 mm Hg) compared to alcohol ablation (21 mm Hg) post-intervention.
  • No significant difference in overall survival between the two groups (P = .1).
  • Patients undergoing septal myectomy had significantly better freedom from reintervention (HR 33.3, P < .001).

Conclusions:

  • While survival is comparable, septal myectomy offers superior early and late reduction of LVOT gradients in obstructive HCM.
  • Septal myectomy is associated with a significantly lower likelihood of reintervention compared to alcohol septal ablation.
  • Surgical septal myectomy is a more effective long-term treatment for LVOT obstruction in HCM.
Abstract

Keywords:
alcohol septal ablationhypertrophic cardiomyopathymyectomy

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