Document Detail


Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis.
MedLine Citation:
PMID:  19233857     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Mahboob Alam; Hisham Dokainish; Nasser M Lakkis
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis     Date:  2009-02-19
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-04     Completed Date:  2009-07-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1080-7     Citation Subset:  IM    
Affiliation:
Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cardiomyopathy, Hypertrophic / surgery,  therapy*
Catheter Ablation / methods*
Clinical Trials as Topic
Ethanol / therapeutic use*
Female
Heart Septum / surgery*
Humans
Male
Middle Aged
Sclerotherapy / methods*
Surgical Procedures, Minimally Invasive / methods
Chemical
Reg. No./Substance:
64-17-5/Ethanol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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