PMID- 19233857
OWN - NLM
STAT- MEDLINE
DCOM- 20090720
LR  - 20220408
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 30
IP  - 9
DP  - 2009 May
TI  - Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a 
      meta-analysis.
PG  - 1080-7
LID - 10.1093/eurheartj/ehp016 [doi]
AB  - AIMS: Our purpose is to conduct a meta-analysis of all published studies 
      comparing alcohol septal ablation (ASA) and myectomy (MM) for drug refractory 
      hypertrophic obstructive cardiomyopathy (HOCM). Alcohol septal ablation is a less 
      invasive alternative to MM for relief of symptoms in patients with drug 
      refractory HOCM. METHODS AND RESULTS: An extensive search of PubMed identified 
      five non-randomized studies comparing ASA and MM. Of 351 patients studied, 183 
      underwent ASA and 168 underwent MM. Patients undergoing ASA were older (mean age 
      54.4 +/- 6.3 vs. 45.0 +/- 4.4 years, P = 0.02). All patients were in New York 
      Heart Association (NYHA) class II-IV. Baseline left ventricular outflow tract 
      (LVOT) gradient was comparable (81.4 +/- 14.3 mmHg in ASA vs. 77.4 +/- 15.5 mmHg 
      in MM, P = 0.2). Although resting LVOT gradient after septal reduction therapy in 
      both groups was <20 mmHg at follow-up, patients undergoing MM had lower LVOT 
      gradient (18.2 +/- 6.7 vs. 10.8 +/- 6.3 mmHg, P < 0.001). Patients in both groups 
      had comparable improvement in NYHA class (1.5 +/- 0.3 in ASA vs. 1.3 +/- 0.2, P = 
      0.2) at follow-up. A higher percentage of patients undergoing ASA required 
      permanent pacemaker (PPM) implantation for complete heart block (18.4 +/- 7.9 vs. 
      3.3 +/- 3.9%, P = 0.04). There was no significant in-hospital mortality 
      difference between the two groups. CONCLUSION: Alcohol septal ablation and MM 
      provide significant reduction in LVOT gradient and NYHA functional class on 
      mid-term follow-up. A higher percentage of patients required PPM after ASA. 
      Randomized trials are needed to confirm current findings.
FAU - Alam, Mahboob
AU  - Alam M
AD  - Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
FAU - Dokainish, Hisham
AU  - Dokainish H
FAU - Lakkis, Nasser M
AU  - Lakkis NM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20090219
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 3K9958V90M (Ethanol)
SB  - IM
MH  - Adult
MH  - Cardiomyopathy, Hypertrophic/surgery/*therapy
MH  - Catheter Ablation/*methods
MH  - Clinical Trials as Topic
MH  - Ethanol/*therapeutic use
MH  - Female
MH  - Heart Septum/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/methods
MH  - Sclerotherapy/*methods
EDAT- 2009/02/24 09:00
MHDA- 2009/07/21 09:00
CRDT- 2009/02/24 09:00
PHST- 2009/02/24 09:00 [entrez]
PHST- 2009/02/24 09:00 [pubmed]
PHST- 2009/07/21 09:00 [medline]
AID - ehp016 [pii]
AID - 10.1093/eurheartj/ehp016 [doi]
PST - ppublish
SO  - Eur Heart J. 2009 May;30(9):1080-7. doi: 10.1093/eurheartj/ehp016. Epub 2009 Feb 
      19.