Clinical characteristics and outcomes of alcohol septal ablation in the era of transcatheter valve interventions
Recommended Citation
Engel Gonzalez P, Gregerson S, Mahmood S, Brooks C, Villablanca PA, Frisoli TM, Lee J, Wyman JF, Wang DD, O'Neill WW, and O'Neill BP. Clinical characteristics and outcomes of alcohol septal ablation in the era of transcatheter valve interventions. Catheter Cardiovasc Interv 2024; 103(6):1023-1034.
Document Type
Article
Publication Date
5-1-2024
Publication Title
Catheterization and cardiovascular interventions
Abstract
BACKGROUND: The clinical efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) have been well-established; however, less is known about outcomes in patients undergoing preemptive ASA before transcatheter mitral valve replacement (TMVR).
AIMS: The goal of this study is to characterize the procedural characteristics and examine the clinical outcomes of ASA in both HCM and pre-TMVR.
METHODS: This retrospective study compared procedural characteristics and outcomes in patient who underwent ASA for HCM and TMVR.
RESULTS: In total, 137 patients were included, 86 in the HCM group and 51 in the TMVR group. The intraventricular septal thickness (mean 1.8 vs. 1.2 cm; p < 0.0001) and the pre-ASA LVOT gradient (73.6 vs. 33.8 mmHg; p ≤ 0.001) were higher in the HCM group vs the TMVR group. The mean volume of ethanol injected was higher (mean 2.4 vs. 1.7 cc; p < 0.0001). The average neo-left ventricular outflow tract area increased significantly after ASA in the patients undergoing TMVR (99.2 ± 83.37 mm(2) vs. 196.5 ± 114.55 mm(2); p = <0.0001). The HCM group had a greater reduction in the LVOT gradient after ASA vs the TMVR group (49.3 vs. 18 mmHg; p = 0.0040). The primary composite endpoint was higher in the TMVR group versus the HCM group (50.9% vs. 25.6%; p = 0.0404) and had a higher incidence of new permanent pacemaker (PPM) (25.5% vs. 18.6%; p = 0.3402). The TMVR group had a higher rate of all-cause mortality (9.8% vs. 1.2%; p = 0.0268).
CONCLUSIONS: Preemptive ASA before TMVR was performed in patients with higher degree of clinical comorbidities, and correspondingly is associated with worse short-term clinical outcomes in comparison to ASA for HCM patients. ASA before TMVR enabled percutaneous mitral interventions in a small but significant minority of patients that would have otherwise been excluded. The degree of LVOT and neoLVOT area increase is significant and predictable.
Medical Subject Headings
Humans; Retrospective Studies; Male; Ethanol; Cardiomyopathy, Hypertrophic; Female; Treatment Outcome; Ablation Techniques; Aged; Cardiac Catheterization; Middle Aged; Risk Factors; Heart Valve Prosthesis Implantation; Time Factors; Mitral Valve; Recovery of Function; Aged, 80 and over; Heart Septum; Mitral Valve Insufficiency
PubMed ID
38639143
Volume
103
Issue
6
First Page
1023
Last Page
1034
