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Dr. Erika Kancler
Objective: Review two studies that assess alcohol septal ablation (ASA) and surgical myectomy as treatment options for patients with drug refractory hypertrophic obstructive cardiomyopathy (HOCM). Background: Controversy exists regarding these two forms of treatment for HCOM. Design: Two observational cohort studies. Methods: A search was done on PubMed, utilizing the terms “hypertrophic cardiomyopathy,” “alcohol septal ablation,” and “myectomy.” The following limits were used: published in the last 15 years, humans, English, and comparative studies. Results: Study One showed that the patients undergoing ASA had a lower periprocedural complication frequency compared to those undergoing myectomy (14% [22 of 161] versus 28% [29 of 102], p-value 0.004). Patients undergoing ASA also had a significantly shorter follow-up stay than those undergoing myectomy (5 days versus 9 days, p-value <0.001). Multivariate analysis showed that age was the only independent predictor of long-term mortality (hazard ratio 1.34, 95% CI 1.08-1.65, p-value 0.007). Study Two showed that the resting pressure gradient (PG) was significantly decreased following both procedures (64 ± 39 mmHg to 24 ± 19 mmHg for ASA, and 62 ± 43 mmHg to 11 ± 6 mmHg for myectomy, both p <0.0001) at 3-month follow up. The NYHA functional class was also significantly improved in both groups; ASA patients from 3.5 ± 0.5 to 1.9 ± 0.7, and myectomy patients from 3.3 ± 0.5 to 1.5 ± 0.7, both p-values < 0.0001). Conclusion: Both ASA and surgical myectomy provide comparable clinical outcomes in patients. ASA is associated with decreased hospital stay and less periprocedural complications. Surgical myectomy provides more complete reduction in pressure gradient, but is a more invasive procedure. ASA is a relatively new procedure therefore further studies will be helpful to validate it's efficacy in comparison to myectomy.
Shellenberger E, Thompson E. Improving clinical outcome in patients with hypertrophic obstructive cardiomyopathy. JMU Scholarly Commons Physician Assistant Capstones. http://commons.lib.jmu.edu/pacapstones/3/ Published August 1, 2016.