In-Hospital Outcomes of Alcohol Septal Ablation in the Treatment of Patients With Hypertrophic Subaortic Stenosis: Results of a Single Center Study

Highlights The review is devoted to the analysis of baseline and in-hospital outcomes of patients with hypertrophic cardiomyopathy after alcohol septal ablation. The results showed that efficacy and safety of alcohol septal ablation in the treatment of patients with hypertrophic cardiomyopathy is comparable to surgical myectomy of the left ventricular outflow tract. Aim. To analyze cases of patients undergoing alcohol septal ablation (ASA) at the Research Institute, assessing patients' baseline status, perioperative data and in-hospital outcomes, and to prove that efficacy and safety of ASA in the treatment of patients with hypertrophic cardiomyopathy (HCM) is comparable to surgical myectomy of the left ventricular outflow tract (LVOT) taking into account the available literature data. Materials and Methods. The study included 25 patients with HCM and LVOT obstruction who underwent ASA at the Research Institute for Complex Issues of Cardiovascular Diseases between 2018 and September 2022. The feasibility of the procedure was based on echocardiographic (LVOT obstruction with peak gradient ≥ 50 mm Hg) and angiographic data (absence of coronary bed lesions, and presence of septal branches with diameter of at least 2 mm). The intervention was performed only in case of a “positive” balloon test, i.e. peak gradient decrease by 30% or more compared to baseline during balloon inflation in the target septal branch. Results. We considered the decrease of LVOT peak gradient by more than 50% compared to baseline to be a success criterion of the procedure. In in-hospital setting there were no endpoints (death, stroke, blockage of left anterior descending artery, permanent pacemaker implantation), and temporary cardiac pacing was required only in 2 cases (8%) due to transient AV blockade. The echocardiography showed that the peak LVOT pressure gradient was 35 [10; 87] mmHg on the 1 st day, and 20 [8; 75] mmHg on the 5 th day. Conclusion. The findings and the experience of other clinics proved that ASA can be used in the treatment of patients with HCM and is comparable to surgical myectomy in terms of efficacy. However, patient selection for ASA should be thorough and include clinical and demographic indicators, and echocardiography and angiography data.