Author + information
- Received January 13, 2014
- Revision received April 21, 2014
- Accepted May 8, 2014
- Published online November 1, 2014.
- Robbert C. Steggerda, MD∗∗ (, )
- Kevin Damman, MD, PhD†,
- Jippe C. Balt, MD, PhD‡,
- Max Liebregts, MD‡,
- Jurriën M. ten Berg, MD, PhD‡ and
- Maarten P. van den Berg, MD, PhD†
- ∗Department of Cardiology, Martini Hospital, Groningen, the Netherlands
- †Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- ‡Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Robbert C. Steggerda, Department of Cardiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, the Netherlands.
Objectives This study compared alcohol septal ablation (ASA) and surgical myectomy for periprocedural complications and long-term clinical outcome in patients with symptomatic hypertrophic obstructive cardiomyopathy.
Background Debate remains whether ASA is equally effective and safe compared with myectomy.
Methods All procedures performed between 1981 and 2010 were evaluated for periprocedural complications and long-term clinical outcome. The primary endpoint was all-cause mortality; secondary endpoints consisted of annual cardiac mortality, New York Heart Association functional class, rehospitalization for heart failure, reintervention, cerebrovascular accident, and myocardial infarction.
Results A total of 161 patients after ASA and 102 patients after myectomy were compared during a maximal follow-up period of 11 years. The periprocedural (30-day) complication frequency after ASA was lower compared with myectomy (14% vs. 27%, p = 0.006), and median duration of in-hospital stay was shorter (5 days [interquartle range (IQR): 4 to 6 days] vs. 9 days [IQR: 6 to 12 days], p < 0.001). After ASA, provoked gradients were higher compared with myectomy (19 [IQR: 10 to 42] vs. 10 [IQR: 7 to 13], p < 0.001). After multivariate analysis, age (per 5 years) (hazard ratio: 1.34 [95% confidence interval: 1.08 to 1.65], p = 0.007) was the only independent predictor for all-cause mortality. Annual cardiac mortality after ASA and myectomy was comparable (0.7% vs. 1.4%, p = 0.15). During follow-up, no significant differences were found in symptomatic status, rehospitalization for heart failure, reintervention, cerebrovascular accident, or myocardial infarction between both groups.
Conclusions Survival and clinical outcome were good and comparable after ASA and myectomy. More periprocedural complications and longer duration of hospital stay after myectomy were offset by higher gradients after ASA.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 13, 2014.
- Revision received April 21, 2014.
- Accepted May 8, 2014.
- American College of Cardiology Foundation