A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy

• Published in: JACC. Heart failure Vol. 3; no. 11; pp. 896 - 905
• Main Authors: Liebregts, Max, MD, Vriesendorp, Pieter A., MD, Mahmoodi, Bakhtawar K., MD, PhD, MPH, Schinkel, Arend F.L., MD, PhD, Michels, Michelle, MD, PhD, ten Berg, Jurriën M., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: alcohol septal ablation; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic - mortality; Cardiomyopathy, Hypertrophic - physiopathology; Cardiomyopathy, Hypertrophic - surgery; Cardiovascular; Catheter Ablation - methods; Heart Septum - surgery; Humans; hypertrophic cardiomyopathy; myectomy; Reoperation; septal reduction therapy; sudden cardiac death; Treatment Outcome; NYHA; myectomy; AAE; CI; septal reduction therapy; left ventricular outflow tract; sudden cardiac death; ICD; LVOT; ASA; New York Heart Association; HCM; adverse arrhythmic events; SCD; hypertrophic cardiomyopathy; confidence interval; implantable cardioverter-defibrillator; alcohol septal ablation
• ISSN: 2213-1779; 2213-1787
• DOI: 10.1016/j.jchf.2015.06.011

Abstract Objectives The aim of this meta-analysis was to compare long-term outcomes after myectomy and alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM). Background Surgical myectomy and ASA are both accepted treatment options for medical therapy–resistant obstructive HCM. Previous meta-analyses only evaluated short-term outcomes. Methods A systematic review was conducted for eligible studies with a follow-up of at least 3 years. Primary outcomes were all-cause mortality and (aborted) sudden cardiac death (SCD). Secondary outcomes were periprocedural complications, left ventricular outflow tract gradient, and New York Heart Association functional class after ≥3 months, and reintervention. Pooled estimates were calculated using a random-effects meta-analysis. Results Sixteen myectomy cohorts (n = 2,791; mean follow-up, 7.4 years) and 11 ASA cohorts (n = 2,013; mean follow-up, 6.2 years) were included. Long-term mortality was found to be similarly low after ASA (1.5% per year) compared with myectomy (1.4% per year, p = 0.78). The rate of (aborted) SCD, including appropriate implantable cardioverter defibrillator shocks, was 0.4% per year after ASA and 0.5% per year after myectomy (p = 0.47). Permanent pacemaker implantation was performed after ASA in 10% of the patients compared with 4.4% after myectomy (p < 0.001). Reintervention was performed in 7.7% of the patients who underwent ASA compared with 1.6% after myectomy (p = 0.001). Conclusions Long-term mortality and (aborted) SCD rates after ASA and myectomy are similarly low. Patients who undergo ASA have more than twice the risk of permanent pacemaker implantation and a 5 times higher risk of the need for additional septal reduction therapy compared with those who undergo myectomy.