Document Detail


Usefulness of clinical, echocardiographic, and procedural characteristics to predict outcome after percutaneous transluminal septal myocardial ablation.
MedLine Citation:
PMID:  18435964     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study was conducted to assess outcomes after percutaneous transluminal septal myocardial ablation (PTSMA) treatment in 131 patients (mean age 56+/-16 years) with obstructive hypertrophic cardiomyopathy. In-hospital and follow-up complications as well as late PTSMA failure (defined as unsatisfactory clinical outcome and a significant residual outflow tract gradient, necessitating reintervention) were noted. Baseline clinical, echocardiographic, and PTSMA characteristics were examined as determinants of outcomes. Also, the effect of ethanol volume and the role of a learning curve were investigated. PTSMA was successful in 90% of the patients. In-hospital and follow-up cardiac events were noted in 20 patients, including cardiac death (in-hospital n=4, follow-up n=1), acute myocardial infarction due to ethanol leakage (n=1), coronary dissection (n=2), nonfatal cardiac tamponade (n=1), and permanent pacemaker (n=6) or cardiac defibrillator (in-hospital n=4, follow-up n=1) implantation. Late PTSMA failure was noted in 12 patients. All baseline characteristics were comparable between successful and failed PTSMA. Ethanol volume was related to peak creatinine kinase value (p<0.0001) but not to late PTSMA failure or greater need for pacemaker implantation. Late PTSMA failure occurred more frequently in PTSMA procedures performed in the early, less experienced time period (p<0.001). In conclusion, this study confirms that PTSMA, although effective, has a relatively high complication rate. Late PTSMA failure could not be predicted by baseline characteristics but could partially be explained by a learning-curve effect. This finding implies that PTSMA procedures should be restricted to experienced centers.
Authors:
Chris van der Lee; Bas Scholzel; Jurriën M ten Berg; Marcel L Geleijnse; Herman H Idzerda; Ron T van Domburg; Wim B Vletter; Patrick W Serruys; Folkert J ten Cate
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Publication Detail:
Type:  Journal Article     Date:  2008-03-10
Journal Detail:
Title:  The American journal of cardiology     Volume:  101     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-25     Completed Date:  2008-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1315-20     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. chrisvanderlee@wanadoo.nl
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Cardiomyopathy, Hypertrophic / mortality,  therapy*
Coronary Angiography
Echocardiography
Ethanol / adverse effects,  therapeutic use*
Female
Heart Septum
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction / chemically induced
Pacemaker, Artificial
Predictive Value of Tests
Proportional Hazards Models
Treatment Failure
Treatment Outcome
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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