| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2005;129:351-358
© 2005 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease |
a Cardiovascular Surgery
b Cardiology, Toronto General Hospital (University Health Network), Toronto
c Division of Cardiology, The Hospital for Sick Children, Toronto
d Queen's University, Kingston, Ontario, Canada
Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.
Received for publication April 29, 2004; revisions received July 9, 2004; accepted for publication August 18, 2004. * Address for reprints: William G. Williams, MD, 555 University Ave, Suite 1525, Toronto, Ontario, Canada M5G1X8 (E-mail: bill.williams{at}sickkids.ca).
OBJECTIVE: In November 1998, our center began offering alcohol ablation as an alternative to surgical myectomy for patients with hypertrophic obstructive cardiomyopathy. Patients with concomitant lesions were referred for surgical intervention, and the others were offered either treatment option. We sought to review the early outcomes for both protocols.
METHODS: One hundred fifty patients had intervention for hypertrophic obstructive cardiomyopathy to June 30, 2003. Sixty patients elected to have alcohol ablation, and 5 crossed over to surgical intervention. A total of 95 patients had a myectomy. Patients having an isolated myectomy (n = 48) are compared with those who had an ablation. Hospital records were reviewed, and follow-up contact (mean, 2.2 years) with the patient or referring cardiologist and recent echocardiographic reports were obtained. Differences in clinical and hemodynamic outcomes between achieved treatment groups were compared after adjustment for differing baseline patient characteristics, including use of a propensity score, to adjust for the nonrandomization.
RESULTS: The patients undergoing alcohol ablation (n = 60) were older (58 vs 48 years) and had fewer associated lesions (1 vs 39 patients), lower pressure gradients (67 vs 73 mm Hg), and similar symptomatic status and degrees of mitral regurgitation compared with those in the myectomy group. Alcohol ablation was abandoned in 6 patients, 5 of whom underwent myectomy. Among the completed alcohol ablations, there were 5 late deaths, and 1 other patient was referred for myectomy. One late death occurred after myectomy. At latest follow-up, 3-year survival is 97%, and 92% of the patients are in New York Heart Association class II or I. Adjusted comparisons showed significantly lower postintervention left ventricular outflow gradients at rest in the myectomy group (5 vs 15 mm Hg), with provocation (14 vs 42 mm Hg), mitral systolic anterior motion (67% vs 29%), and New York Heart Association class. No significant difference was present in postintervention septal thickness or freedom from postintervention pacing, although in time-related analysis, the 3-year freedom from pacing is 88% versus 59% (P = .02), favoring myectomy.
CONCLUSION: Either alcohol ablation or myectomy offers substantial clinical improvement for patients with hypertrophic obstructive cardiomyopathy. Hemodynamic resolution of the obstruction and its sequelae is more complete with myectomy. Residual lesions after alcohol ablation might affect longer-term outcomes.
This article has been cited by other articles:
|
|
 |
|
  M. Alam, H. Dokainish, and N. M. Lakkis Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis Eur. Heart J., May 1, 2009; 30(9): 1080 - 1087. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G S Soor, A Luk, E Ahn, J R Abraham, A Woo, A Ralph-Edwards, and J Butany Hypertrophic cardiomyopathy: current understanding and treatment objectives J. Clin. Pathol., March 1, 2009; 62(3): 226 - 235. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. L. Fernandes, C. Nielsen, S. F. Nagueh, A. E. Herrin, C. Slifka, J. Franklin, and W. H. Spencer III Follow-Up of Alcohol Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy: The Baylor and Medical University of South Carolina Experience 1996 to 2007 J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 561 - 570. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Steendijk, E Meliga, M Valgimigli, F J Ten Cate, and P W Serruys Acute effects of alcohol septal ablation on systolic and diastolic left ventricular function in patients with hypertrophic obstructive cardiomyopathy Heart, October 1, 2008; 94(10): 1318 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S R Ommen, P M Shah, and A J Tajik Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy: past, present and future Heart, October 1, 2008; 94(10): 1276 - 1281. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Sorajja, U. Valeti, R. A. Nishimura, S. R. Ommen, C. S. Rihal, B. J. Gersh, D. O. Hodge, H. V. Schaff, and D. R. Holmes Jr Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy Circulation, July 8, 2008; 118(2): 131 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Rhodes, Z. M. Hijazi, and R. J. Sommer Pathophysiology of Congenital Heart Disease in the Adult, Part II: Simple Obstructive Lesions Circulation, March 4, 2008; 117(9): 1228 - 1237. [Full Text] [PDF]
|
|
|
|
|
|
E. Durand, E. Mousseaux, P. Coste, R. Pilliere, O. Dubourg, L. Trinquart, G. Chatellier, A. Hagege, M. Desnos, and A. Lafont Non-surgical septal myocardial reduction by coil embolization for hypertrophic obstructive cardiomyopathy: early and 6 months follow-up Eur. Heart J., February 1, 2008; 29(3): 348 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Fifer and G. J. Vlahakes Management of Symptoms in Hypertrophic Cardiomyopathy Circulation, January 22, 2008; 117(3): 429 - 439. [Full Text] [PDF]
|
|
|
|
 |
|
 N. G. Smedira, B. W. Lytle, H. M. Lever, J. Rajeswaran, G. Krishnaswamy, R. K. Kaple, D. O.W. Dolney, and E. H. Blackstone Current Effectiveness and Risks of Isolated Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Ann. Thorac. Surg., January 1, 2008; 85(1): 127 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. Hansen and N. Merchant MRI of Hypertrophic Cardiomyopathy: Part 2, Differential Diagnosis, Risk Stratification, and Posttreatment MRI Appearances Am. J. Roentgenol., December 1, 2007; 189(6): 1344 - 1352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. McLeod, S. R. Ommen, M. J. Ackerman, P. L. Weivoda, W. K. Shen, J. A. Dearani, H. V. Schaff, A. J. Tajik, and B. J. Gersh Surgical septal myectomy decreases the risk for appropriate implantable cardioverter defibrillator discharge in obstructive hypertrophic cardiomyopathy Eur. Heart J., November 1, 2007; 28(21): 2583 - 2588. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Olivotto, S. R. Ommen, M. S. Maron, F. Cecchi, and B. J. Maron Surgical Myectomy Versus Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy: Will There Ever Be a Randomized Trial? J. Am. Coll. Cardiol., August 28, 2007; 50(9): 831 - 834. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. F. Nagueh, J. M. Buergler, M. A. Quinones, W. H. Spencer III, and G. M. Lawrie Outcome of Surgical Myectomy After Unsuccessful Alcohol Septal Ablation for the Treatment of Patients With Hypertrophic Obstructive Cardiomyopathy J. Am. Coll. Cardiol., August 21, 2007; 50(8): 795 - 798. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Maron Surgical Myectomy Remains the Primary Treatment Option for Severely Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy Circulation, July 10, 2007; 116(2): 196 - 206. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Fifer Most Fully Informed Patients Choose Septal Ablation Over Septal Myectomy Circulation, July 10, 2007; 116(2): 207 - 216. [Full Text] [PDF]
|
|
|
|
|
|
A. W. Heldman, K. C. Wu, T. P. Abraham, and D. E. Cameron Myectomy or Alcohol Septal Ablation: Surgery and Percutaneous Intervention Go Another Round J. Am. Coll. Cardiol., January 23, 2007; 49(3): 358 - 360. [Full Text] [PDF]
|
|
|
|
|
|
C. J Knight Alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Heart, September 1, 2006; 92(9): 1339 - 1344. [Full Text] [PDF]
|
|
|
|
|
|
R. H. Jones The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2094 - 2107. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
