Key result
Alcohol septal ablation matches surgical myectomy for long-term mortality, with fewer complications but more re-interventions.
Why the study?
Surgical myectomy and alcohol septal ablation are both invasive options for symptomatic HOCM despite medical therapy, but their comparative efficacy required meta-analytic evaluation.
Does alcohol septal ablation compare favorably to surgical septal myectomy for improving mortality, symptoms, and hemodynamics in symptomatic adults with hypertrophic obstructive cardiomyopathy?
Meta-Analysis (n=4,547)
Yes
Does alcohol septal ablation compare favorably to surgical septal myectomy for improving mortality, symptoms, and hemodynamics in symptomatic adults with hypertrophic obstructive cardiomyopathy?
Absolute Event Rate: 8.72% vs 7.84%
p-value: p=0.42
While alcohol septal ablation and septal myectomy offer comparable survival benefits for HOCM, myectomy provides superior long-term LVOT gradient reduction and symptom relief, whereas ablation offers lower peri-procedural complications but higher pacing and re-intervention rates.
ASA and myectomy yield similar long-term survival in HOCM; extends evidence by quantifying lower complications yet higher re-interventions with ablation.
Surgical myectomy (SM) and alcohol septal ablation (ASA) are two invasive therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), despite medical therapy. This meta-analysis aims to compare the efficacy of the two procedures. We searched all electronic databases until February 2020 for clinical trials and cohorts comparing clinical outcomes of ASA and SM treatment of patients with HOCM. The primary endpoint was all-cause mortality, cardiovascular (CV) mortality, sudden cardiac death (SCD), re-intervention, and complications. Secondary endpoints included relief of clinical symptoms and drop of left ventricular outflow tract (LVOT) gradient. Twenty studies (4547 patients; 2 CTs and 18 cohorts) comparing ASA vs. SM with a mean follow-up of 47 ± 28.7 months were included. Long term (8.72 vs. 7.84%, p = 0.42) and short term (1.12 vs. 1.27%, p = 0.93) all-cause mortality, CV mortality (2.48 vs. 3.66%, p = 0.26), SCD (1.78 vs. 0.76%, p = 0.20) and stroke (0.36 vs. 1.01%, p = 0.64) were not different between procedures. ASA was associated with lower peri-procedural complications (5.57 vs. 10.5%, p = 0.04) but higher rate of re-interventions (10.1 vs. 0.27%; p < 0.001) and pacemaker dependency (12.4 vs. 4.31%, p = 0.0004) compared to SM. ASA resulted in less reduction in LVOT gradient (−47.8 vs. −58.4 mmHg, p = 0.01) and less improvement of clinical symptoms compared to SM (New York Heart Association (NYHA) class III/IV, 82.4 vs. 94.5%, p < 0.001, angina 53.2 vs. 84.2%, p = 0.02). Thus, ASA and SM treatment of HOCM carry a similar risk of mortality. Peri-procedural complications are less in alcohol ablation but re-intervention and pacemaker implantations are more common. These results might impact the procedure choice in individual patients, for the best clinical outcome.
No takes yet. Share an insight, caveat, or question.
Bytyçi et al. (2020) conducted a meta-analysis in Hypertrophic obstructive cardiomyopathy (HOCM) (n=4,547). Alcohol septal ablation vs. Surgical septal myectomy was evaluated on Long-term all-cause mortality (p=0.42). Alcohol septal ablation and septal myectomy carried a similar risk of long-term all-cause mortality, though ablation was associated with fewer peri-procedural complications and higher re-intervention rates.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: