[Long-term outcome of patients with hypertrophic obstructive cardiomyopathy post percutaneous transluminal septal
S W Zheng1, H Y Shi1, J J Dai1
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Insights
Percutaneous transluminal septal ablation (PTSMA) offers a safe and effective treatment for hypertrophic obstructive cardiomyopathy (HOCM), demonstrating long-term survival rates comparable to surgical myectomy. Age over 65 is identified as a risk factor for mortality post-PTSMA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a significant cause of morbidity and mortality.
- Percutaneous transluminal septal ablation (PTSMA) and surgical myectomy are primary treatment options for HOCM.
- Long-term outcomes comparing PTSMA and surgical myectomy require further evaluation.
Purpose of the Study:
- To evaluate the long-term outcomes of patients with HOCM treated with PTSMA.
- To compare the efficacy and survival rates of PTSMA versus surgical myectomy in HOCM patients.
- To identify risk factors associated with mortality after PTSMA in HOCM.
Main Methods:
- Retrospective analysis of 104 HOCM patients undergoing PTSMA and 32 undergoing surgical myectomy.
- Comparison of clinical data, procedural details, and complications between groups.
- Multivariate Cox regression and Kaplan-Meier survival analysis were used to assess outcomes and risk factors.
Main Results:
- PTSMA achieved an immediate success rate of 66%.
- Long-term survival rates at 5, 10, and 15 years post-PTSMA were 90.1%, 78.3%, and 56.9% respectively.
- Age ≥ 65 years was an independent risk factor for all-cause death (HR=2.697, P=0.020); no significant difference in survival rates was found between PTSMA and surgical myectomy groups (P > 0.05).
Conclusions:
- PTSMA is a safe and effective treatment for HOCM.
- Long-term survival following PTSMA is comparable to that of surgical myectomy.
- Age is a critical factor influencing mortality risk in HOCM patients treated with PTSMA.
Abstract:
Objective: To evaluate the long-term outcome of patients with hypertrophic obstructive cardiomyopathy(HOCM) after percutaneous transluminal septal ablation(PTSMA). Methods: HOCM patients who underwent PTSMA and surgical myectomy at the Chest Hospital of Shanghai Jiao Tong University from April 2001 to February 2019 were included in this retrospective analysis. Patients were divided into PTSMA group and surgical myectomy group. In addition, patients undergoing PTSMA were further divided into HOCM-PTSMA non-survivor group and HOCM-PTSMA survivor group. The general clinical information, procedural/surgical information and complications during hospitalization were compared between groups. Multivariate Cox regression model was used to analyze the independent risk factors for all-cause death in HOCM patients after PTSMA. Results: A total of 104 patients with HOCM who underwent PTSMA were enrolled. Mean age of the patients was (54±15) years old, including 41 females (38.7%). The follow-up time was 37.5(14.3, 76.8) months. At the last follow-up, 12 patients died (HOCM-PTSMA non-survivor group) and 92 were alive(HOCM-PTSMA survivor group). The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher(P=0.036), and the posterior wall of the left ventricle was thicker(P=0.006) in the HOCM-PTSMA non-survivor group than in the HOCM-PTSMA survivor group. The immediate success rate of PTSMA in this cohort was 66%(70/104). The amount of absolute alcohol during the operation in the HOCM-PTSMA non-survivor group was (2.9±0.8) ml, which tended to be higher as compared to that in the HOCM-PTSMA survivor group((2.4±1.0)ml, P=0.056). Kaplan-Meier survival curve analysis showed that patients with HOCM who underwent PTSMA had an all-cause mortality-free survival rate of 90.1%, 78.3%, and 56.9% at 5, 10 and 15 years, and a HOCM-free survival rate of 91.3%, 79.4% and 57.7% at 5, 10 and 15 years, respectively. Multivariate Cox regression analysis showed that age≥ 65 years was an independent risk factor for all-cause death after PTSMA in patients with HOCM (HR=2.697, 95%CI 1.292-18.977, P=0.020). There were 32 patients in the surgical myectomy group. The proportion of patients with NYHA function class Ⅲ/Ⅳ was higher than that in the PTSMA group(P<0.001), while age, gender, and major comorbidities(atrial fibrillation, coronary heart disease, hypertension, and diabetes) as well as the left atrium dimension were all similar between the two groups(all P>0.05). Patients in the surgical myectomy group were followed up for 38.0(17.6, 64.2)months, and no deaths occurred during the follow-up period. Kaplan-Meier survival curve analysis showed that there were no statistically significant differences in all-cause-free and HOCM-free survival rates between patients in PTSMA group and surgical myectomy group(P=0.089 and 0.110, respectively). Conclusion: PTSMA is safe and effective for the treatment of patients with HOCM, and the long-term survival rate of patients after PTSMA is similar as patients undergoing classical surgical myectomy surgery.
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