Outcomes of Alcohol Septal Ablation in Patients With Severe Left Ventricular Outflow Tract Obstruction: A Propensity Score Matching Analysis

• Published in: Canadian journal of cardiology Vol. 39; no. 11; pp. 1622 - 1629
• Main Authors: Veselka, Josef, Liebregts, Max, Cooper, Robert, Faber, Lothar, Januska, Jaroslav, Tesarkova, Klara Hulikova, Hansen, Peter Riis, Seggewiss, Hubert, Hansvenclova, Eva, Bonaventura, Jiri, Vejtasova, Veronika, Ten Berg, Jurriën, Stables, Rodney Hilton, Jensovsky, Michael
• Format: Journal Article
• Language: English
• Published: England 01.11.2023
• Subjects: Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - diagnosis; Cardiomyopathy, Hypertrophic - surgery; Dyspnea - etiology; Female; Humans; Propensity Score; Retrospective Studies; Treatment Outcome; Ventricular Outflow Obstruction - surgery; Ventricular Outflow Obstruction, Left
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2023.06.417

The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg. We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO. A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P = 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P = 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P = 0.02). After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.