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Long-Term Survival After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: A 16-Year Experience
Valerian Fernandes1, Ahmadreza Karimianpour, Jeremy D Rier
1Division of Cardiology, Department of Medicine, Medical University of South Carolina, 114 Doughty Street, MSC 592, Charleston, SC 29464 USA. fernandv@musc.edu.
Insights
Alcohol septal ablation (ASA) effectively treats hypertrophic obstructive cardiomyopathy (HOCM), showing safe and comparable long-term survival rates to the general population. This study confirms ASA
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Alcohol septal ablation (ASA) is a recognized treatment for medically refractory hypertrophic obstructive cardiomyopathy (HOCM).
- Concerns exist regarding potential arrhythmia risks and long-term survival due to iatrogenic septal infarction.
- This study evaluates long-term outcomes and procedural refinements in a large HOCM patient cohort.
Purpose of the Study:
- To assess the long-term survival of patients undergoing Alcohol Septal Ablation (ASA).
- To evaluate the safety and efficacy of ASA in managing hypertrophic obstructive cardiomyopathy (HOCM).
- To analyze improvements in procedural techniques over time.
Main Methods:
- A cohort of 580 patients undergoing 664 ASA procedures between 1999 and 2015 was analyzed.
- Procedural details, outcomes, and long-term survival were recorded.
- Survival rates were compared to demographically matched control populations.
Main Results:
- 94% of patients achieved >50% reduction in left ventricular outflow tract (LVOT) gradient.
- Significant improvements were observed in New York Heart Association functional class and exercise duration.
- Long-term survival at 1, 5, 10, and 15 years was 98%, 92%, 84%, and 81%, comparable to controls (Standardized Mortality Ratio 0.84).
Conclusions:
- Alcohol septal ablation (ASA) is a safe and effective treatment for symptomatic HOCM.
- Long-term survival following ASA is comparable to the general US population.
- ASA offers a viable therapeutic option for patients with refractory HOCM.
Background:
Alcohol septal ablation (ASA) is an accepted treatment for medically refractory hypertrophic obstructive cardiomyopathy (HOCM). The procedural and medium-term outcomes have been reassuring. The iatrogenic targeted septal infarction has raised theoretical concerns about risk of arrhythmia and long-term survival. In this study, we describe the long-term survival in a large cohort of patients from a single referral center and the iterative improvement in procedural technique since its inception.
Methods:
This cohort includes 580 consecutive patients who underwent 664 ASA procedures between the years 1999 and 2015. Procedural details and outcomes are described. Long-term survival is compared with expected survival of demographically similar controls.
Results:
Fifty-four percent were women and 85% were Caucasian. At the time of ablation, mean age was 57 ± 15 years, septal thickness was 2.1 ± 0.5 cm, and left ventricular outflow tract (LVOT) gradient was 72 ± 40 mm Hg at rest and 102 ± 58 mm Hg with Valsalva provocation. Mean follow-up was 8.0 ± 4.3 years. LVOT gradient reduction >50% was achieved in 94% of patients with reduction in New York Heart Association functional class scores and increase in exercise treadmill duration. Procedural mortality was 0.9%. Over the 16-year period, survival estimates at 1, 5, 10, and 15 years were 98%, 92%, 84%, and 81%, respectively, which are comparable to demographically similar controls. The standardized mortality ratio was 0.84 (95% confidence interval, 0.66-1.06); P=.09.
Conclusions:
ASA appears to be a safe and effective treatment for symptomatic HOCM refractory to medical therapy with long-term survival comparable to a demographically similar United States population.
