National experience of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: A long-term
Evgenii Shloido1, Kirill Popov1, Sergey Chernyshov2
1City Hospital No.2, Department of interventional cardiology, Saint-Petersburg, Russia.
Insights
Alcohol septal ablation (ASA) is a safe and effective treatment for obstructive hypertrophic cardiomyopathy (HCM). This study shows favorable short- and long-term outcomes, with repeated ASA yielding results comparable to single procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Hypertrophic cardiomyopathy (HCM) affects 1:200 individuals globally.
- Surgical and interventional treatments for HCM are established in Western countries.
- Limited data exists on alcohol septal ablation (ASA) outcomes in the Russian Federation.
Purpose of the Study:
- To evaluate the safety and efficacy of ASA in patients with obstructive hypertrophic cardiomyopathy (oHCM).
- To assess short-term and long-term outcomes following ASA.
- To compare outcomes between single and repeated ASA procedures.
Main Methods:
- A multicenter registry (RASA) was conducted.
- 597 oHCM patients undergoing ASA were enrolled.
- Outcomes included 30-day and long-term mortality, pacemaker implantation, left ventricular outflow tract (LVOT) gradient, heart failure class, and sudden cardiac death.
Main Results:
- 30-day mortality was 0.7%, with 7% requiring permanent pacemakers.
- Mean LVOT gradient decreased significantly (64 to 20 mmHg, p < 0.0001).
- Mean NYHA class improved from 2.3 to 1.3 (p < 0.001).
- 1-, 5-, and 10-year survival rates were 97.4%, 93.2%, and 84.9%, respectively.
- Outcomes for repeated ASA were non-inferior to single ASA.
Conclusions:
- Alcohol septal ablation is a safe and effective treatment for oHCM in the short and long term.
- Repeated ASA demonstrates comparable long-term survival and clinical outcomes to single ASA.
- The RASA registry provides valuable insights into ASA outcomes in the Russian population.
Objectives:
Hypertrophic cardiomyopathy (HCM) is a widespread disease with an incidence of 1:200 in the general population and its surgical and interventional treatment is well-developed in western countries. This study is focusing on outcomes of HCM patients after alcohol septal ablation in Russian Federation.
Methods:
We conducted a multicenter registry to evaluate outcomes of obstructive hypertrophic cardiomyopathy (oHCM) patients after ASA. Our study was focused on the following outcomes: (i) 30-day mortality, (ii) 30-day permanent pacemaker implantations, (iii) a residual obstruction occurrence, (iv) final maximal left ventricular outflow tract gradient, (v) long-term mortality, (vi) final heart failure functional class, (vii) freedom from sudden cardiac death. We conducted secondary analysis to assess outcomes in patients with single versus repeated ASA. The mean follow-up was 71 ± 47 months.
Results:
A total of 597 consecutive patients (54.9 % female) were enrolled in the Russian Alcohol Septal Reduction (RASA) registry from three interventional groups. The mean age was 56 ± 14 years. Thirty-day mortality rate was 0.7 % (4 patients). Permanent pacemakers were implanted in 42 (7 %) cases in 30-days follow-up. The resting LVOT gradient reduced from 64 ± 28 to 20 ± 13 mmHg (p < 0.0001), and the mean NYHA class decreased from 2.3 ± 0.7 to 1.3 ± 0.5 (p < 0.001). Long-term survival rates were as follows: 97.4 (95%CI: 96.2-98.7) %, 93.2 (95%CI: 91.0-95.3) %, 84.9 (95%CI: 80.7-89.4) % at 1-, 5-, 10-year follow-up, respectively. Patients after repeated ASA. had similar long-term survival comparing to those who underwent single ASA (weighted log rank p value = 0.254). Heart failure class in the long-term and final gradient at the last follow-up were not statistically different between groups under study (p > 0.05).
Conclusions:
In our registry, alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy was safe in the short- and long-term follow-up. Outcomes of patients underwent repeated ASA were non-inferior to those after single ASA.
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