Follow-Up of Alcohol Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy. The Baylor and Medical University of South Carolina Experience 1996 to 2007

Valerian L. Fernandes, Christopher Nielsen, Sherif F. Nagueh, Amy E. Herrin, Christine Slifka, Jennifer Franklin, William H. Spencer

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Objectives: This study sought to determine the long-term outcome of alcohol septal ablation (ASA). Background: There are inadequate data on the long-term outcome of ASA for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Methods: Six hundred and twenty-nine patients were enrolled consecutively (1996 to 2007) and 98.4% (n = 619) underwent ASA with 92% follow-up in 2007. Evaluation included deaths, procedural complications, pacemaker requirement, repeat ASA, and myectomy/valve surgery. Follow-up parameters included angina (Canadian Cardiovascular Society score), dyspnea (New York Heart Association functional class), exercise time, and echocardiographic indices (septal thickness, ejection fraction, resting and provoked gradients). Results: Ethanol (2.6 ± 1.0 ml) was injected into 1.3 ± 0.5 septal arteries, inducing a septal infarct. Complications included death 1% (n = 6), permanent pacemaker requirement 8.2% (n = 52), coronary dissection 1.3% (n = 8), and worsening mitral regurgitation 0.3% (n = 2). The mean follow-up was 4.6 ± 2.5 years (range: 3 months to 10.2 years). During follow-up, New York Heart Association functional class decreased from 2.8 ± 0.6 to 1.2 ± 0.5 (p < 0.001); Canadian Cardiovascular Society angina score decreased from 2.1 ± 0.9 to 1.0 ± 0 (p < 0.001); and exercise time increased from 4.8 ± 3.3 to 8.2 ± 1.0 (p < 0.001) min. The resting and provoked left ventricular outflow tract gradients decreased progressively (p < 0.001) and remained low during follow-up. The septal thickness decreased from 2.1 ± 0.5 cm to 1.0 ± 0.1 cm (p < 0.001) and the ejection fraction decreased from 68 ± 9% to 62 ± 3% (p < 0.001). The survival estimates at 1, 5, and 8 years were 97%, 92%, and 89%, respectively. Conclusions: The initial benefits of ASA were maintained during follow-up.

Original languageEnglish (US)
Pages (from-to)561-570
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume1
Issue number5
DOIs
StatePublished - Oct 2008

Keywords

  • alcohol
  • cardiomyopathy
  • hypertrophy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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