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. 2024 May 3;38(5):ivae058.
doi: 10.1093/icvts/ivae058.

Extended septal myectomy versus alcohol septal ablation: clinical results at a national referral centre

Juan Esteban de Villarreal-Soto  1 , Juan Francisco Oteo-Domínguez  2 , Daniel Martínez-López  1 , Elsa Carolina Ríos-Rosado  1 , Beatriz Vera-Puente  1 , Jean Carlo Olivo-Soto  1 , Fernando Arízaga-Arce  1 , Pablo García-Pavía  2 , Víctor Manuel Ospina Mosquera  1 , Susana Villar García  1 , Jessica García Suárez  3 , Miguel Ángel Cavero  2 , Carlos Esteban Martín-López  1 , Alberto Forteza-Gil  1
Affiliations

Extended septal myectomy versus alcohol septal ablation: clinical results at a national referral centre

Juan Esteban de Villarreal-Soto et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Extended septal myectomy and alcohol septal ablation are 2 invasive treatments for hypertrophic obstructive cardiomyopathy. Our goal was to compare which of these techniques achieved a higher reduction in gradients, improvement in New York Heart Association (NYHA) functional class and reduction in medical treatment.

Methods: It is a single-centre observational and retrospective analysis. We used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. The odds ratio or coefficient along with the 95% confidence interval was estimated according to the group and adjusted for the corresponding preprocedural variables and EuroSCORE II.

Results: A total of 78 patients underwent septal myectomy, and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced to a higher degree in comparison to ablation: 21.0 mmHg [P < 0.001, 95% confidence interval -30.7; -11.3], and 34.3 mmHg (P < 0.001, -49.1; -19.5) respectively. Those patients who received a myectomy had a lower probability of having moderate mitral regurgitation (odds ratio = 0.18, P = 0.054). Patients after septal myectomy were more likely to be NYHA functional class I (80.4%), whereas patients after ablation were more likely to be NYHA functional class III (48%). Both groups continued with beta-blocker therapy, but disopyramide could be discontinued after the myectomy in more cases (20%-36% vs 59%-1.3%; P < 0.001), and there was a tendency to discontinue calcium channel blockers (48%-16% vs 15.4-3.8%; P = 0.054).

Conclusions: After adjustment using preprocedural gradients and EuroSCORE II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation.

Keywords: Alcohol septal ablation; Hypertrophic obstructive cardiomyopathy; Inverse-probability weighted regression-adjustment; Septal myectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

None
Graphical abstract
Figure 1:
Figure 1:
New York Heart Association group percentage pre- and post-alcohol septal ablation/septal myectomy. The colour boxes indicate the post-procedure New York Heart Association percentage according to their corresponding previous New York Heart Association values (horizontal boxes).
Figure 2:
Figure 2:
Kaplan–Meier survival functions.
See this image and copyright information in PMC

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