PMID- 28329292
OWN - NLM
STAT- MEDLINE
DCOM- 20171018
LR  - 20181202
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 24
IP  - 6
DP  - 2017 Jun 1
TI  - Surgical septal myectomy or alcohol septal ablation: which approach offers better 
      outcomes for patients with hypertrophic obstructive cardiomyopathy?
PG  - 951-961
LID - 10.1093/icvts/ivx001 [doi]
AB  - A best evidence topic in cardiac surgery was written according to a structured 
      protocol. The question addressed was whether surgical septal myectomy (SM) is 
      more beneficial than alcohol septal ablation (ASA) in patients with hypertrophic 
      obstructive cardiomyopathy. Altogether 218 articles were found using the reported 
      search, of which 15 studies represented the best evidence to answer the clinical 
      question. There were 14 observational studies and 1 meta-analysis study. The 
      authors, journal, date and country of publication, patient group studied, study 
      type, relevant outcomes and results of these articles are tabulated. Surgical SM 
      was generally performed in younger patients whereas percutaneous ASA was favoured 
      in patients with advanced age and significant co-morbidities. In a large study 
      comprising 716 patients, the reduction of median residual left ventricular 
      outflow tract (LVOT) gradient at 3 months was comparable after ASA 
      (102 +/- 52-10 mmHg) and SM (92 +/- 39-9 mmHg). The New York Heart Association (NYHA) 
      functional class and symptomatic improvement for either approach was comparable. 
      Findings from the meta-analysis study showed that patients who underwent ASA had 
      a higher incidence of post-procedure device implantation (odds ratio 3.09; 
      P < 0.00001), as reported in 6 other studies. The risk of permanent pacemaker 
      insertion during follow-up (FU) varied between 2.4-12.5% in SM and 1.7-22.0% in 
      ASA. Isolated surgical myectomy and ASA are safe and effective in abolishing 
      outflow obstruction, although the resolution of LVOT pressure gradient is more 
      complete with surgery. The post-procedural and late mortality rates between the 2 
      groups are consistently low and comparable in carefully selected patients. 
      Nonetheless, ASA is associated with the increased likelihood of complications 
      such as permanent pacemaker implantation, early sustained-VT and VF, and 
      re-intervention. Overall, when performed by experienced cardiologists and 
      surgeons, both techniques are safe and effective in most cases and therefore 
      treatment should be offered based on patient choice.
CI  - (c) The Author 2017. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Poon, Shi Sum
AU  - Poon SS
AD  - Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart 
      and Chest Hospital, Liverpool, UK.
FAU - Field, Mark
AU  - Field M
AD  - Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart 
      and Chest Hospital, Liverpool, UK.
FAU - Gupta, Dhiraj
AU  - Gupta D
AD  - Interventional Cardiology, Department of Cardiology, Liverpool Heart and Chest 
      Hospital, Liverpool, UK.
FAU - Cameron, Duke
AU  - Cameron D
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
RN  - 3K9958V90M (Ethanol)
SB  - IM
MH  - Ablation Techniques/*methods
MH  - Cardiac Surgical Procedures/*methods
MH  - Cardiomyopathy, Hypertrophic/diagnosis/*surgery
MH  - Ethanol/*pharmacology
MH  - Heart Septum/*surgery
MH  - Humans
MH  - Middle Aged
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Alcohol septal ablation
OT  - Hypertrophic obstructive cardiomyopathy
OT  - Surgical septal myectomy
EDAT- 2017/03/23 06:00
MHDA- 2017/10/19 06:00
CRDT- 2017/03/23 06:00
PHST- 2016/06/17 00:00 [received]
PHST- 2017/01/02 00:00 [accepted]
PHST- 2017/03/23 06:00 [pubmed]
PHST- 2017/10/19 06:00 [medline]
PHST- 2017/03/23 06:00 [entrez]
AID - 3058519 [pii]
AID - 10.1093/icvts/ivx001 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):951-961. doi: 
      10.1093/icvts/ivx001.