PMID- 17707185
OWN - NLM
STAT- MEDLINE
DCOM- 20071010
LR  - 20131121
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 50
IP  - 8
DP  - 2007 Aug 21
TI  - Outcome of surgical myectomy after unsuccessful alcohol septal ablation for the 
      treatment of patients with hypertrophic obstructive cardiomyopathy.
PG  - 795-8
AB  - OBJECTIVES: We sought to determine the outcome of myectomy after unsuccessful 
      alcohol ablation. BACKGROUND: Alcohol septal ablation results in symptomatic 
      improvement and a reduction in dynamic obstruction in most hypertrophic 
      obstructive cardiomyopathy patients. However, a few patients remain with severe 
      symptoms and obstruction and need surgery. The outcome of these cases is not well 
      known. METHODS: The medical records of 375 patients who underwent alcohol 
      ablation at our institution were reviewed. Twenty patients (5.3%, mean age 53 +/- 
      18 years, 17 women) subsequently needed surgical myectomy. The New York Heart 
      Association (NYHA) functional class, angina class, exercise duration, left 
      ventricular outflow tract (LVOT) gradient, ejection fraction, and septal 
      thickness were tabulated. The anatomy and distribution of the septal perforator 
      arteries were examined. RESULTS: After ablation, NYHA functional class (3 to 2.5; 
      p < 0.05) and LVOT gradient (93 +/- 23 mm Hg to 71 +/- 26 mm Hg; p < 0.05) were 
      slightly improved, without a change in exercise duration (171 +/- 124 s to 168 
      +/- 148 s; p > 0.5). Myectomy was performed at 19 +/- 15 months after ablation. 
      There was no operative mortality, but permanent pacing was needed in 2 patients 
      after surgery, and 3 other cases needed pacing before, or as a complication of, 
      alcohol ablation. A significant improvement was noted, with the NYHA functional 
      class decreasing to 1, exercise duration increasing to 423 +/- 171 s, and LVOT 
      gradient decreasing to 6 +/- 11 mm Hg (all p < 0.05 versus post-alcohol 
      ablation). CONCLUSIONS: Myectomy can be successfully performed after failed 
      alcohol ablation, but with a higher incidence of heart block than in cases where 
      only surgery is performed. Otherwise, alcohol ablation does not appear to 
      adversely affect surgical outcome.
FAU - Nagueh, Sherif F
AU  - Nagueh SF
AD  - Methodist DeBakey Heart Center and Department of Cardiology, Methodist Hospital, 
      Houston, Texas, USA. snagueh@tmh.tmc.edu
FAU - Buergler, John M
AU  - Buergler JM
FAU - Quinones, Miguel A
AU  - Quinones MA
FAU - Spencer, William H 3rd
AU  - Spencer WH 3rd
FAU - Lawrie, Gerald M
AU  - Lawrie GM
LA  - eng
PT  - Journal Article
DEP - 20070806
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 3K9958V90M (Ethanol)
SB  - IM
MH  - Aged
MH  - *Cardiac Catheterization
MH  - *Cardiac Surgical Procedures
MH  - Cardiomyopathy, Hypertrophic/*surgery
MH  - Ethanol/*therapeutic use
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pacemaker, Artificial
MH  - Retrospective Studies
MH  - Salvage Therapy
MH  - Treatment Failure
EDAT- 2007/08/21 09:00
MHDA- 2007/10/11 09:00
CRDT- 2007/08/21 09:00
PHST- 2007/01/05 00:00 [received]
PHST- 2007/04/09 00:00 [revised]
PHST- 2007/04/10 00:00 [accepted]
PHST- 2007/08/21 09:00 [pubmed]
PHST- 2007/10/11 09:00 [medline]
PHST- 2007/08/21 09:00 [entrez]
AID - S0735-1097(07)01762-7 [pii]
AID - 10.1016/j.jacc.2007.04.065 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2007 Aug 21;50(8):795-8. doi: 10.1016/j.jacc.2007.04.065. Epub 
      2007 Aug 6.