PTSMA resulted in a smaller decrease in mean SAM grade (1.3 vs 0.5, P<0.05) and more periprocedural complications compared to surgical myectomy with MLE in patients with HOCM and enlarged AMVL.
Cohort (n=72)
Does percutaneous transluminal septal myocardial ablation improve hemodynamics and reduce complications compared to septal myectomy with mitral leaflet extension in symptomatic hypertrophic obstructive cardiomyopathy patients with enlarged anterior mitral valve leaflets?
In symptomatic HOCM patients with enlarged anterior mitral valve leaflets, surgical myectomy with mitral leaflet extension provides superior hemodynamic results and fewer periprocedural complications compared to PTSMA.
Absolute Event Rate: 1.3% vs 0.5%
p-value: p=<0.05
BACKGROUND: The purpose of this study was to compare percutaneous transluminal septal myocardial ablation (PTSMA) and septal myectomy combined with mitral leaflet extension (MLE) in symptomatic hypertrophic obstructive cardiomyopathy patients with an enlarged anterior mitral valve leaflet (AMVL). Both PTSMA and myectomy reduce septal thickness and left ventricular outflow tract (LVOT) gradient; however, an uncorrected enlarged AMVL may predispose to residual systolic anterior motion (SAM) after successful standard myectomy or PTSMA. Myectomy with MLE previously demonstrated superior hemodynamic results compared with standard myectomy, but its value relative to PTSMA is unknown. METHODS AND RESULTS: Twenty-nine patients (aged 44+/-12 years) underwent myectomy with MLE, and 43 patients (aged 52+/-17 years) underwent PTSMA. Mitral leaflet area was similar in both groups (16.7+/-3.4 versus 15.9+/-2.7 cm2, respectively). After PTSMA, 2 patients died, 4 needed a reintervention, and 4 required a permanent pacemaker for complete heart block. After surgery, only 1 patient needed a reintervention. At 1-year follow-up, LVOT gradients did not differ between surgical and PTSMA patients (17+/-14 versus 23+/-19 mm Hg, respectively). Preinterventional mitral regurgitation grade was more severe in the surgical group, but with myectomy combined with MLE, the residual grade was similar to that of PTSMA. Mean SAM grade decreased significantly more after surgery (from 2.9+/-0.3 to 0.5+/-0.7 mm Hg versus from 2.8+/-0.5 to 1.3+/-0.9 corrected, P<0.05). CONCLUSIONS: PTSMA in these selected patients with hypertrophic obstructive cardiomyopathy had more periprocedural complications and resulted in more reinterventions. Hemodynamic results (SAM grade and reduction in mitral regurgitation) were better in surgical patients.
Lee et al. (Tue,) conducted a cohort in Hypertrophic obstructive cardiomyopathy with enlarged anterior mitral valve leaflet (n=72). Percutaneous transluminal septal myocardial ablation (PTSMA) vs. Septal myectomy combined with mitral leaflet extension (MLE) was evaluated on Mean SAM grade (p=<0.05). PTSMA resulted in a smaller decrease in mean SAM grade (1.3 vs 0.5, P<0.05) and more periprocedural complications compared to surgical myectomy with MLE in patients with HOCM and enlarged AMVL.
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