Author(s):
Aguiar Rosa, S ; Fiarresga, A ; Galrinho, A ; Cacela, D ; Ramos, R ; de Sousa, L ; Gonçalves, A ; Bernardes, L ; Patrício, L ; Branco, LM ; Cruz Ferreira, R
Date: 2019
Persistent ID: http://hdl.handle.net/10400.17/3763
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): Ablation Techniques; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Echocardiography; Ethanol; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome; Ventricular Outflow Obstruction; Ventricular Septum; HSM CAR
Description
Introduction: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. Methods: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. Results: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. Conclusion: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.
