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Review
. 2020 Sep 23;9(10):3062.
doi: 10.3390/jcm9103062.

Alcohol Septal Ablation versus Septal Myectomy Treatment of Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Ibadete Bytyçi  1   2   3 , Stefano Nistri  4 , Stellan Mörner  1 , Michael Y Henein  1   5   6
Affiliations
Review

Alcohol Septal Ablation versus Septal Myectomy Treatment of Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Ibadete Bytyçi et al. J Clin Med. .

Abstract

Surgical myectomy (SM) and alcohol septal ablation (ASA) are two invasive therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), despite medical therapy. This meta-analysis aims to compare the efficacy of the two procedures. We searched all electronic databases until February 2020 for clinical trials and cohorts comparing clinical outcomes of ASA and SM treatment of patients with HOCM. The primary endpoint was all-cause mortality, cardiovascular (CV) mortality, sudden cardiac death (SCD), re-intervention, and complications. Secondary endpoints included relief of clinical symptoms and drop of left ventricular outflow tract (LVOT) gradient. Twenty studies (4547 patients; 2 CTs and 18 cohorts) comparing ASA vs. SM with a mean follow-up of 47 ± 28.7 months were included. Long term (8.72 vs. 7.84%, p = 0.42) and short term (1.12 vs. 1.27%, p = 0.93) all-cause mortality, CV mortality (2.48 vs. 3.66%, p = 0.26), SCD (1.78 vs. 0.76%, p = 0.20) and stroke (0.36 vs. 1.01%, p = 0.64) were not different between procedures. ASA was associated with lower peri-procedural complications (5.57 vs. 10.5%, p = 0.04) but higher rate of re-interventions (10.1 vs. 0.27%; p < 0.001) and pacemaker dependency (12.4 vs. 4.31%, p = 0.0004) compared to SM. ASA resulted in less reduction in LVOT gradient (-47.8 vs. -58.4 mmHg, p = 0.01) and less improvement of clinical symptoms compared to SM (New York Heart Association (NYHA) class III/IV, 82.4 vs. 94.5%, p < 0.001, angina 53.2 vs. 84.2%, p = 0.02). Thus, ASA and SM treatment of HOCM carry a similar risk of mortality. Peri-procedural complications are less in alcohol ablation but re-intervention and pacemaker implantations are more common. These results might impact the procedure choice in individual patients, for the best clinical outcome.

Keywords: alcohol septal ablation; hypertrophic obstructive cardiomyopathy; septal myectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Risk ratio of outcome with alcohol septal ablation (ASA) vs. surgical myectomy (SM); (a) Long-term all-cause mortality; (b) short-term all-cause mortality. CI, confidence interval.
Figure 2
Figure 2
Risk ratio of outcome with septal ablation versus surgical myectomy, (a) cardiovascular mortality; (b) sudden cardiac death (SCD). ASA, alcohol septal ablation; SM, surgical myectomy; CI, confidence interval. (c) Stroke.
Figure 3
Figure 3
Risk ratio of outcome with septal ablation versus surgical myectomy, (a) Peri-procedural complications; (b) Re-intervention; (c) PM implantation. ASA, alcohol septal ablation; SM, surgical myectomy; CI, confidence interval; PM, pacemaker.
Figure 4
Figure 4
Summary of clinical outcome in two groups of treatment. ASA, alcohol septal ablation; SM, surgical myectomy; CI, confidence interval, CV, cardiovascular, SCD, sudden cardiac death, RR, relative risk, NYHA, New York Heart Association.
Figure 5
Figure 5
Left ventricular outflow tract (LVOT) gradient mean change; (1.1 ASA) ASA group; ((1.2 SM) SM group. ASA, alcohol septal ablation; SM, surgical myectomy; CI, confidence interval.
Figure 6
Figure 6
Comparison of clinical improvements between ASA vs. SM; (a) NYHA class; (b) Angina. ASA, alcohol septal ablation; SM, surgical myectomy; CI, confidence interval. NYHA, New York Heart Association.
See this image and copyright information in PMC

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