Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy

A propensity score–matched cohort

Anita Nguyen, Hartzell V Schaff, Dustin Hang, Rick A. Nishimura, Jeffrey B. Geske, Joseph A. Dearani, Brian D. Lahr, Steve R. Ommen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: In patients with hypertrophic cardiomyopathy, obstruction of the left ventricular outflow tract can be relieved by surgical septal myectomy or alcohol septal ablation, but uncertainty remains regarding long-term results and comparative effectiveness of alcohol septal ablation. This study aims to compare short- and long-term outcomes of the 2 procedures. Methods: Between December 1998 and September 2016, 2407 patients underwent septal myectomy and 211 patients underwent alcohol septal ablation at our institution. After 2:1 propensity score matching, the study cohort included 334 patients who underwent myectomy and 167 patients who underwent alcohol septal ablation. Results: Median (interquartile range) ages of patients in the myectomy and alcohol septal ablation groups were 65 (58-71) years and 64 (56-73) years (P =.9), respectively. After intervention, median resting left ventricular outflow tract gradient at predischarge transthoracic echocardiography was 0 (0-10) mm Hg in the myectomy group (n = 288) and 21 (10-60) mm Hg in the alcohol septal ablation group (n = 63) (P <.001, tested at baseline gradients of 30 and 50 mm Hg). There were no differences in survival between the 2 groups (risk of death for alcohol septal ablation vs myectomy, hazard ratio, 1.5; 95% confidence interval, 0.9-2.6; P =.1). Survival of patients undergoing septal myectomy was better than that of an age-, sex-, and race-matched US population (82% vs 75% at 12 years, P =.01). Reintervention for left ventricular outflow tract obstruction was more likely to occur in patients who received alcohol septal ablation (hazard ratio, 33.3; 95% confidence interval, 4.4-250.6; P <.001). Conclusions: There were no differences in survival of patients undergoing myectomy or alcohol septal ablation, but freedom from reintervention and early and late reduction of left ventricular outflow tract gradient are superior in patients undergoing septal myectomy.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Hypertrophic Cardiomyopathy
Alcohols
Ventricular Outflow Obstruction
Survival
Confidence Intervals
Propensity Score
Uncertainty
Echocardiography
Cohort Studies

Keywords

  • alcohol septal ablation
  • hypertrophic cardiomyopathy
  • myectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy : A propensity score–matched cohort. / Nguyen, Anita; Schaff, Hartzell V; Hang, Dustin; Nishimura, Rick A.; Geske, Jeffrey B.; Dearani, Joseph A.; Lahr, Brian D.; Ommen, Steve R.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Nguyen, Anita ; Schaff, Hartzell V ; Hang, Dustin ; Nishimura, Rick A. ; Geske, Jeffrey B. ; Dearani, Joseph A. ; Lahr, Brian D. ; Ommen, Steve R. / Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy : A propensity score–matched cohort. In: Journal of Thoracic and Cardiovascular Surgery. 2018.
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abstract = "Objectives: In patients with hypertrophic cardiomyopathy, obstruction of the left ventricular outflow tract can be relieved by surgical septal myectomy or alcohol septal ablation, but uncertainty remains regarding long-term results and comparative effectiveness of alcohol septal ablation. This study aims to compare short- and long-term outcomes of the 2 procedures. Methods: Between December 1998 and September 2016, 2407 patients underwent septal myectomy and 211 patients underwent alcohol septal ablation at our institution. After 2:1 propensity score matching, the study cohort included 334 patients who underwent myectomy and 167 patients who underwent alcohol septal ablation. Results: Median (interquartile range) ages of patients in the myectomy and alcohol septal ablation groups were 65 (58-71) years and 64 (56-73) years (P =.9), respectively. After intervention, median resting left ventricular outflow tract gradient at predischarge transthoracic echocardiography was 0 (0-10) mm Hg in the myectomy group (n = 288) and 21 (10-60) mm Hg in the alcohol septal ablation group (n = 63) (P <.001, tested at baseline gradients of 30 and 50 mm Hg). There were no differences in survival between the 2 groups (risk of death for alcohol septal ablation vs myectomy, hazard ratio, 1.5; 95{\%} confidence interval, 0.9-2.6; P =.1). Survival of patients undergoing septal myectomy was better than that of an age-, sex-, and race-matched US population (82{\%} vs 75{\%} at 12 years, P =.01). Reintervention for left ventricular outflow tract obstruction was more likely to occur in patients who received alcohol septal ablation (hazard ratio, 33.3; 95{\%} confidence interval, 4.4-250.6; P <.001). Conclusions: There were no differences in survival of patients undergoing myectomy or alcohol septal ablation, but freedom from reintervention and early and late reduction of left ventricular outflow tract gradient are superior in patients undergoing septal myectomy.",
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T2 - A propensity score–matched cohort

AU - Nguyen, Anita

AU - Schaff, Hartzell V

AU - Hang, Dustin

AU - Nishimura, Rick A.

AU - Geske, Jeffrey B.

AU - Dearani, Joseph A.

AU - Lahr, Brian D.

AU - Ommen, Steve R.

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KW - alcohol septal ablation

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KW - myectomy

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