Alcohol septal ablation and surgical myectomy both effectively relieve left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, requiring a multidisciplinary team approach.
Does alcohol septal ablation or surgical myectomy improve symptoms in patients with hypertrophic obstructive cardiomyopathy?
In the absence of randomized trials, the choice between surgical myectomy and alcohol septal ablation for obstructive HCM should be individualized by a multidisciplinary cardiomyopathy team.
PURPOSE OF REVIEW: Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outflow tract obstruction (LVOTO) often experience severe symptoms and functional limitation. Relief of LVOTO can be achieved by two invasive interventions, i.e., surgery myectomy and alcohol septal ablation (ASA), leading in experienced hands to a dramatic improvement in clinical status. Despite extensive research, however, the choice of the best option in individual patients remains challenging and poses numerous clinical dilemmas. RECENT FINDINGS: Invasive strategies have been recently incorporated in recommendations for the diagnosis and treatment of HCM on both sides of the Atlantic. These guidelines are based on a bulk of well-designed but retrospective studies as well as on expert opinions. Evidence now exists that adequate evaluation and management of HCM requires a multidisciplinary team capable of choosing the best available options. Management of LVOTO still varies largely based on local expertise and patient preference. Following the trend that has emerged for other cardiac diseases amenable to invasive interventions, the concept of a "HCM heart team" is coming of age.
Pelliccia et al. (Fri,) conducted a review in Hypertrophic Obstructive Cardiomyopathy. Alcohol septal ablation vs. Surgical myectomy was evaluated. Alcohol septal ablation and surgical myectomy both effectively relieve left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, requiring a multidisciplinary team approach.