Safety and Outcomes of Alcohol Septal Ablation Prior to Transcatheter Mitral Valve Replacement
Key result
Preemptive ASA before TMVR shows similar safety to ASA for HCM.
- P=0.195
- n=102
Why the study?
Patients undergoing TMVR for mitral valve disease caused by severe mitral annular calcification are at risk of left ventricular outflow obstruction, and the safety and outcomes of preemptive ASA in this setting are not well established.
Does preemptive alcohol septal ablation prior to TMVR have similar safety and procedural outcomes compared to its established use in hypertrophic obstructive cardiomyopathy?
Population
102 patients undergoing ASA (22 prior to TMVR, 80 for HCM)
Comparison
ASA prior to TMVR vs ASA for HCM
Design
Retrospective cohort study
Follow-up
30 days
Authors
Discussion
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Implication
Supports ASA to enlarge neo-LVOT before TMVR; leaves open net benefit versus HCM benchmarks given high pacemaker rates.
Study Design
Type
Cohort (n=102)
Structured PICO
Does preemptive alcohol septal ablation prior to TMVR have similar safety and procedural outcomes compared to its established use in hypertrophic obstructive cardiomyopathy?
P
Population
102 patients who underwent alcohol septal ablation either preemptively for transcatheter mitral valve replacement (n=22) or for hypertrophic obstructive cardiomyopathy (n=80).
E
Exposure
Preemptive alcohol septal ablation (ASA) prior to transcatheter mitral valve replacement (TMVR).
C
Comparator
Alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HCM).
O
Outcome
Procedural characteristics and outcomes (including neo-left ventricular outflow tract area, complete heart block requiring pacemaker, ventricular arrhythmia, stroke, major bleeding, and 30-day mortality).safety
Main Result
Absolute Event Rate: 35% vs 21%
p-value: p=0.195
Preemptive alcohol septal ablation prior to TMVR effectively increases neo-LVOT area with short-term safety outcomes comparable to its established use in HCM, though it carries a substantial risk of complete heart block.
Cite This Study
Elhadi et al. (2022) conducted a cohort in Mitral valve disease with severe mitral annular calcification or hypertrophic obstructive cardiomyopathy (n=102). Alcohol septal ablation for TMVR vs. Alcohol septal ablation for HCM was evaluated on Post-ASA complete heart block requiring a permanent pacemaker (p=0.195). Preemptive alcohol septal ablation prior to TMVR had similar safety to ASA for HCM, with complete heart block requiring a pacemaker in 35% vs 21% (P=0.195) and 30-day mortality of 0% vs 4%.