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European Heart Journal Advance Access originally published online on February 19, 2009
European Heart Journal 2009 30(9):1080-1087; doi:10.1093/eurheartj/ehp016
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis

Mahboob Alam, Hisham Dokainish and Nasser M. Lakkis*

Section of Cardiology, Baylor College of Medicine, Houston, TX, USA

Received 9 October 2008; revised 25 December 2008; accepted 8 January 2009; online publish-ahead-of-print 19 February 2009.

* Corresponding author. Tel: +1 713 873 2083, Fax: +1 713 873 4903, Email: nlakkis{at}bcm.edu

Aims: Our purpose is to conduct a meta-analysis of all published studies comparing alcohol septal ablation (ASA) and myectomy (MM) for drug refractory hypertrophic obstructive cardiomyopathy (HOCM). Alcohol septal ablation is a less invasive alternative to MM for relief of symptoms in patients with drug refractory HOCM.

Methods and results: An extensive search of PubMed identified five non-randomized studies comparing ASA and MM. Of 351 patients studied, 183 underwent ASA and 168 underwent MM. Patients undergoing ASA were older (mean age 54.4 ± 6.3 vs. 45.0 ± 4.4 years, P = 0.02). All patients were in New York Heart Association (NYHA) class II–IV. Baseline left ventricular outflow tract (LVOT) gradient was comparable (81.4 ± 14.3 mmHg in ASA vs. 77.4 ± 15.5 mmHg in MM, P = 0.2). Although resting LVOT gradient after septal reduction therapy in both groups was <20 mmHg at follow-up, patients undergoing MM had lower LVOT gradient (18.2 ± 6.7 vs. 10.8 ± 6.3 mmHg, P < 0.001). Patients in both groups had comparable improvement in NYHA class (1.5 ± 0.3 in ASA vs. 1.3 ± 0.2, P = 0.2) at follow-up. A higher percentage of patients undergoing ASA required permanent pacemaker (PPM) implantation for complete heart block (18.4 ± 7.9 vs. 3.3 ± 3.9%, P = 0.04). There was no significant in-hospital mortality difference between the two groups.

Conclusion: Alcohol septal ablation and MM provide significant reduction in LVOT gradient and NYHA functional class on mid-term follow-up. A higher percentage of patients required PPM after ASA. Randomized trials are needed to confirm current findings.

Key Words: Cardiomyopathy • Alcohol • Ablation • Myectomy


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