Gregerson S, Mahmood S, Brooks C, Gonzalez PE, Villablanca P, Frisoli T, Lee J, Wang DD, O'Neill W, and O'Neill B. TCT-353 Clinical Characteristics and Outcomes of Alcohol Septal Ablation in the Era of Transcatheter Valve Interventions. J Am Coll Cardiol 2022; 80(12):B143.
J Am Coll Cardiol
Background: Alcohol septal ablation (ASA) is an alternative to surgical myectomy for left ventricular outflow tract (LVOT) obstruction in HCM and pre-emptive before transcatheter mitral valve replacement (TMVR) to prevent LVOT obstruction. This study aimed to evaluate the procedural characteristics and outcomes of ASA in contemporary practice.
Methods: This was a single-center retrospective study of 137 patients undergoing ASA for HCM and TMVR at Henry Ford Hospital from January 2010 to August 2021. Patient/procedure characteristics and outcomes were assessed. The primary endpoint was an adverse composite of new pacemaker requirement (PPM), stroke, sustained ventricular tachycardia, resuscitated cardiac arrest, and all-cause mortality within 30 days.
Results: Eighty-six cases were performed for HCM, and 51 cases were performed for TMVR. Of the entire cohort, 27.7% cases met the primary endpoint with common adverse events being PPM (21%), cardiac arrest (6.5%), and mortality (4.3%). The HCM subgroup had a PPM of 18.7% and mortality of 1.1%. The TMVR subgroup had a PPM of 25.4% and mortality of 9.8%. The LVOT gradient decreased by a mean of 43 mm Hg for the entire cohort, 51.75 mm Hg in the HCM group, and 19.03 mm Hg in the TMVR group. Residual LVOT gradients above 30 mm Hg were noted in the HCM group (41.8%) and the TMVR group (13.7%).
Conclusion: This is the largest study including patients who underwent ASA for pre-emptive TMVR in addition to HCM. Most primary endpoint events consisted of a new pacemaker requirement. The mortality rate in the HCM reflects prior studies, suggesting a mortality of 1% to 2%. The mortality rate in pre-emptive TMVR was higher than previously reported by our group (6.7%).
Categories: STRUCTURAL: Alcohol Septal Ablation/HOCM