Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery

Jian Xin, Takahiro Shiota, Harry M. Lever*, Samir R. Kapadia, Marta Sitges, David N. Rubin, Fabrice Bauer, Neil L. Greenberg, Deborah A. Agler, Jeanne K. Drinko, Maureen Martin, Murat Tuzcu, Nicholas G. Smedira, Bruce Lytle, James D. Thomas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

203 Scopus citations

Abstract

OBJECTIVES: This study was conducted to evaluate follow-up results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy. BACKGROUND: Controversy exists with regard to these two forms of treatment for patients with HOCM. METHODS: Of 51 patients with HOCM treated, 25 were treated by PTSMA and 26 patients via myectomy. Two-dimensional echocardiograms were performed before both procedures, immediately afterwards and at a three-month follow-up. The New York Heart Association (NYHA) functional class was obtained before the procedures and at follow-up. RESULTS: Interventricular septal thickness was significantly reduced at follow-up in both groups (2.3 ± 0.4 cm vs. 1.9 ± 0.4 cm for septal ablation and 2.4 ± 0.6 cm vs. 1.7 ± 0.2 cm for myectomy, both p < 0.001). Estimated by continuous-wave Doppler, the resting pressure gradient (PG) across the left ventricular outflow tract (LVOT) significantly decreased immediately after the procedures in both groups (64 ± 39 mm Hg vs. 28 ± 29 mm Hg for PTSMA, 62 ± 43 mm Hg vs. 7 ± 7 mm Hg for myectomy, both p < 0.0001). At three-month follow-up, the resting PG remained lower in the PTSMA and myectomy groups (24 ± 19 mm Hg and 11 ± 6 mm Hg, respectively, vs. those before procedures, both p < 0.0001). The NYHA functional class was also significantly improved in both groups (3.5 ± 0.5 vs. 1.9 ± 0.7 for PTSMA, 3.3 ± 0.5 vs. 1.5 ± 0.7 for myectomy, both p < 0.0001). CONCLUSIONS: Both myectomy and PTSMA reduce LVOT obstruction and significantly improve NYHA functional class in patients with HOCM. However, there are benefits and drawbacks for each therapeutic method that must be counterbalanced when deciding on treatment for LVOT obstruction.

Original languageEnglish (US)
Pages (from-to)1994-2000
Number of pages7
JournalJournal of the American College of Cardiology
Volume38
Issue number7
DOIs
StatePublished - 2001

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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