Septal Myectomy After Failed Septal Alcohol Ablation

Overview

Journal Ann Cardiothorac Surg

Publisher AME Publishing Company

Date 2017 Sep 26

PMID 28944181

Citations 2

Authors

Eduard Quintana

Pietro Bajona

Maria Jose Arguis

Susanna Prat-Gonzalez

Affiliations

Soon will be listed here.

Abstract

Despite septal myectomy remaining the gold standard septal reduction therapy for hypertrophic obstructive cardiomyopathy (HOCM), there has been a disproportionate use of alcohol septal ablation (ASA) worldwide. Absolute resolution of left ventricular outflow tract (LVOT) obstruction with ASA is not achieved in a substantial proportion of patients. The mechanisms of failure from ASA are partially understood and described. Residual obstruction in hypertrophic cardiomyopathy is associated with worse clinical outcomes and mortality. There is a growing number of patients who present with significant residual gradients after ASA and require a rescue septal myectomy operation, which then carries an increased risk of perioperative complications and life-long sequelae. This contrasts with the excellent outcomes achieved by septal myectomy without previous percutaneous intervention. Despite complete resolution of obstruction in rescue myectomy, the outcomes remain compromised by the prior ASA.

Citing Articles

Septal myectomy with mitral valve surgery in patients after alcohol septal ablation.

Rudenko K, Lazoryshynets V, Nevmerzhytska L, Tregubova M, Danchenko P Interact Cardiovasc Thorac Surg. 2022; 34(5):723-730.

PMID: 35106584 PMC: 9070461. DOI: 10.1093/icvts/ivac010.

Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation.

Yang Q, Zhu C, Cui H, Tang B, Wang S, Yu Q J Thorac Dis. 2021; 13(2):1055-1065.

PMID: 33717578 PMC: 7947546. DOI: 10.21037/jtd-20-2779.

References

Ommen S, Maron B, Olivotto I, Maron M, Cecchi F, Betocchi S . Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005; 46(3):470-6. DOI: 10.1016/j.jacc.2005.02.090. View

Sorajja P, Valeti U, Nishimura R, Ommen S, Rihal C, Gersh B . Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2008; 118(2):131-9. DOI: 10.1161/CIRCULATIONAHA.107.738740. View

Agarwal S, Tuzcu E, Desai M, Smedira N, Lever H, Lytle B . Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010; 55(8):823-34. DOI: 10.1016/j.jacc.2009.09.047. View

Seiler C, Stoller M, Pitt B, Meier P . The human coronary collateral circulation: development and clinical importance. Eur Heart J. 2013; 34(34):2674-82. DOI: 10.1093/eurheartj/eht195. View

Firoozi S, Elliott P, Sharma S, Murday A, Brecker S, Hamid M . Septal myotomy-myectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical, haemodynamic and exercise outcomes. Eur Heart J. 2002; 23(20):1617-24. DOI: 10.1053/euhj.2002.3285. View

Sorajja P, Ommen S, Holmes Jr D, Dearani J, Rihal C, Gersh B . Survival after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2012; 126(20):2374-80. DOI: 10.1161/CIRCULATIONAHA.111.076257. View

Valeti U, Nishimura R, Holmes D, Araoz P, Glockner J, Breen J . Comparison of surgical septal myectomy and alcohol septal ablation with cardiac magnetic resonance imaging in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2007; 49(3):350-7. DOI: 10.1016/j.jacc.2006.08.055. View

Angelini P . The "1st septal unit" in hypertrophic obstructive cardiomyopathy: a newly recognized anatomo-functional entity, identified during recent alcohol septal ablation experience. Tex Heart Inst J. 2007; 34(3):336-46. PMC: 1995043. View

OMahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C . A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J. 2013; 35(30):2010-20. DOI: 10.1093/eurheartj/eht439. View

10.

Sigwart U . Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995; 346(8969):211-4. DOI: 10.1016/s0140-6736(95)91267-3. View

11.

Spacek M, Zemanek D, Tomasov P, Veselka J . Early opening of dormant septal collaterals during alcohol septal ablation: a possible hazard of remote necrosis. Can J Cardiol. 2013; 29(11):1531.e5-7. DOI: 10.1016/j.cjca.2013.07.003. View

12.

Maron B, Dearani J, Ommen S, Maron M, Schaff H, Nishimura R . Low Operative Mortality Achieved With Surgical Septal Myectomy: Role of Dedicated Hypertrophic Cardiomyopathy Centers in the Management of Dynamic Subaortic Obstruction. J Am Coll Cardiol. 2015; 66(11):1307-1308. DOI: 10.1016/j.jacc.2015.06.1333. View

13.

Veselka J, Tomasov P, Januska J, Krejci J, Adlova R . Obstruction after alcohol septal ablation is associated with cardiovascular mortality events. Heart. 2016; 102(22):1793-1796. DOI: 10.1136/heartjnl-2016-309699. View

14.

Maron B . Commentary and re-appraisal: surgical septal myectomy vs. alcohol ablation: after a decade of controversy and mismatch between clinical practice and guidelines. Prog Cardiovasc Dis. 2012; 54(6):523-8. DOI: 10.1016/j.pcad.2012.04.008. View

15.

Maron B, Spirito P, Shen W, Haas T, Formisano F, Link M . Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007; 298(4):405-12. DOI: 10.1001/jama.298.4.405. View

16.

Valero S, Moreno R, Galeote G, Sanchez-Recalde A . Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: take care with the collaterals. Rev Esp Cardiol. 2009; 62(8):941-2. DOI: 10.1016/s1885-5857(09)72661-1. View

17.

Rigopoulos A, Sepp R, Palinkas A, Ungi I, Kremastinos D, Seggewiss H . Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: collateral vessel communication between septal branches. Int J Cardiol. 2006; 113(2):e67-9. DOI: 10.1016/j.ijcard.2006.04.057. View

18.

Liebregts M, Vriesendorp P, Mahmoodi B, Schinkel A, Michels M, Ten Berg J . A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy. JACC Heart Fail. 2015; 3(11):896-905. DOI: 10.1016/j.jchf.2015.06.011. View

19.

Ralph-Edwards A, Woo A, McCrindle B, Shapero J, Schwartz L, Rakowski H . Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score. J Thorac Cardiovasc Surg. 2005; 129(2):351-8. DOI: 10.1016/j.jtcvs.2004.08.047. View

20.

Veselka J, Jensen M, Liebregts M, Januska J, Krejci J, Bartel T . Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry. Eur Heart J. 2016; 37(19):1517-23. DOI: 10.1093/eurheartj/ehv693. View