Surgical septal myectomy and alcohol septal ablation are both accepted therapies for obstructive hypertrophic cardiomyopathy, though myectomy provides more definitive relief of obstruction with lower need for subsequent device implantation.
May inform procedural choice in obstructive HCM; leaves open need for head-to-head RCTs on long-term outcomes.
Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and is associated with symptoms of heart failure and increased risk of sudden cardiac death. The most common condition is obstruction of the left ventricular outflow tract. Surgical septal myectomy and alcohol septal ablation are the 2 accepted modes of septal reduction therapy and are indicated when there are advanced symptoms and a peak left ventricular outflow gradient ≥50 mmHg. Advantages of alcohol septal ablation are limited groin approach, reduction of obstruction of the left ventricular outflow tract and functional improvement, but there are higher chances for intracardiac device implantation and residual obstruction. Septal myectomy offers very low mortality, absolute and immediate resolution of obstruction of the left ventricular outflow tract and survival comparative to a matched general population with almost negligible residual obstruction. It is recommended that patients with obstructive hypertrophic cardiomyopathy should be treated at experienced centres.
No takes yet. Share an insight, caveat, or question.
Mestres et al. (2018) studied this question.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: