Comparison of percutaneous transluminal septal myocardial ablation versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy--a meta analysis.
BACKGROUND
The effects of percutaneous transluminal septal myocardial ablation (PTSMA) with septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM) are not thoroughly compared.


METHODS
Three articles comparing the effects of PTSMA and septal myectomy treatment for HOCM were identified from a search in Pubmed, and a meta analysis was conducted.


RESULTS
177 patients (86 underwent PTSMA and 91 underwent septal myectomy) were included. Interventricular septum thickness was decreased from 22.1 to 15.1 mm (p<0.05) in PTSMA group and from 22.0 to 13.9 mm (p<0.05) in septal myectomy group; left ventricular end-diastolic dimension was increased from 41.8 to 45.2 mm (p<0.05) in PTSMA group and from 41.8 to 43.9 mm (p<0.05) in septal myectomy group; NYHA class was improved from 3.17 to 1.47 (p<0.05) in PTSMA group and from 2.97 to 1.36 (p<0.05) in septal myectomy group; there were no differences in the two groups. However, left ventricular outflow tract gradient was decreased from 76.0 to 15.7 mm Hg (p<0.05) in PTSMA group and from 74.7 to 9.4 mm Hg (p<0.05) in septal myectomy group and the effect of septal myectomy was better than PTSMA (p<0.05).


CONCLUSIONS
The effects of septal myectomy treatment for HOCM are better with regard to relief of LVOT gradient, and lower risk of pacemaker requirement, compared to PTSMA. Large randomized clinical trials further comparing the two treatments are suggested.
Zeng
Zhiyu
Z
Center for Arrhythmia Diagnosis and Treatment, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. zsfuwai@vip.163.com
Wang
Fangzheng
F
Dou
Xiangfeng
X
Zhang
Shu
S
Pu
Jielin
J
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D004452:Echocardiography; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016896:Treatment Outcome