PMID- 32977442
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201103
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 9
IP  - 10
DP  - 2020 Sep 23
TI  - Alcohol Septal Ablation versus Septal Myectomy Treatment of Obstructive 
      Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis.
LID - 10.3390/jcm9103062 [doi]
LID - 3062
AB  - Surgical myectomy (SM) and alcohol septal ablation (ASA) are two invasive 
      therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy 
      (HOCM), despite medical therapy. This meta-analysis aims to compare the efficacy 
      of the two procedures. We searched all electronic databases until February 2020 
      for clinical trials and cohorts comparing clinical outcomes of ASA and SM 
      treatment of patients with HOCM. The primary endpoint was all-cause mortality, 
      cardiovascular (CV) mortality, sudden cardiac death (SCD), re-intervention, and 
      complications. Secondary endpoints included relief of clinical symptoms and drop 
      of left ventricular outflow tract (LVOT) gradient. Twenty studies (4547 patients; 
      2 CTs and 18 cohorts) comparing ASA vs. SM with a mean follow-up of 47 +/- 28.7 
      months were included. Long term (8.72 vs. 7.84%, p = 0.42) and short term (1.12 
      vs. 1.27%, p = 0.93) all-cause mortality, CV mortality (2.48 vs. 3.66%, p = 
      0.26), SCD (1.78 vs. 0.76%, p = 0.20) and stroke (0.36 vs. 1.01%, p = 0.64) were 
      not different between procedures. ASA was associated with lower peri-procedural 
      complications (5.57 vs. 10.5%, p = 0.04) but higher rate of re-interventions 
      (10.1 vs. 0.27%; p < 0.001) and pacemaker dependency (12.4 vs. 4.31%, p = 0.0004) 
      compared to SM. ASA resulted in less reduction in LVOT gradient (-47.8 vs. -58.4 
      mmHg, p = 0.01) and less improvement of clinical symptoms compared to SM (New 
      York Heart Association (NYHA) class III/IV, 82.4 vs. 94.5%, p < 0.001, angina 
      53.2 vs. 84.2%, p = 0.02). Thus, ASA and SM treatment of HOCM carry a similar 
      risk of mortality. Peri-procedural complications are less in alcohol ablation but 
      re-intervention and pacemaker implantations are more common. These results might 
      impact the procedure choice in individual patients, for the best clinical 
      outcome.
FAU - Bytyci, Ibadete
AU  - Bytyci I
AUID- ORCID: 0000-0002-8996-4257
AD  - Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, 
      Sweden.
AD  - Universi College, Bardhosh, 10000 Prishtina, Kosovo.
AD  - Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, 
      Kosovo.
FAU - Nistri, Stefano
AU  - Nistri S
AD  - Cardiology Service, CMSR-Veneto Medica, 204-36077 Altavilla Vicentina, Italy.
FAU - Morner, Stellan
AU  - Morner S
AD  - Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, 
      Sweden.
FAU - Henein, Michael Y
AU  - Henein MY
AD  - Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, 
      Sweden.
AD  - Molecular and Clinic Research Institute, St George University, Brunel University, 
      London SW17 0QT, UK.
AD  - Institute of Fluid Dynamics, Brunel University, London UB8 3PH, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200923
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC7598206
OTO - NOTNLM
OT  - alcohol septal ablation
OT  - hypertrophic obstructive cardiomyopathy
OT  - septal myectomy
COIS- The authors declare no conflict of interest.
EDAT- 2020/09/27 06:00
MHDA- 2020/09/27 06:01
PMCR- 2020/09/23
CRDT- 2020/09/26 01:00
PHST- 2020/08/13 00:00 [received]
PHST- 2020/09/15 00:00 [revised]
PHST- 2020/09/17 00:00 [accepted]
PHST- 2020/09/26 01:00 [entrez]
PHST- 2020/09/27 06:00 [pubmed]
PHST- 2020/09/27 06:01 [medline]
PHST- 2020/09/23 00:00 [pmc-release]
AID - jcm9103062 [pii]
AID - jcm-09-03062 [pii]
AID - 10.3390/jcm9103062 [doi]
PST - epublish
SO  - J Clin Med. 2020 Sep 23;9(10):3062. doi: 10.3390/jcm9103062.