Percutaneous septal ablation after unsuccessful surgical myectomy for patients with hypertrophic obstructive cardiomyopathy.
OBJECTIVE
To evaluate the long-term outcome of percutaneous septal ablation (PTSMA) after a previous myectomy.


BACKGROUND
Myectomy usually results in symptomatic improvement and reduction of dynamic obstruction in hypertrophic obstructive cardiomyopathy patients (HOCM-pts.). However, a few pts. remain with severe symptoms and obstruction, and need additional interventions.


METHODS
We reviewed our database of 450 pts. who underwent PTSMA in our institution, and identified 11 (7 women, 4 men, mean age: 50 +/- 14 years) with residual or recurrent NYHA class symptoms > or =III and significant left ventricular outflow obstruction (LVOTO) despite a previous myectomy 4 +/- 5 years ago. In-hospital and follow-up data covering 6 +/- 4 years, focusing on mortality and morbidity, symptoms, exercise capacity, and echocardiographic measures were collected.


RESULTS
PTSMA was performed by injection of 3.6 +/- 2.9 ml of alcohol. There was no peri-procedural or late death in this cohort. CK peaked at 614 +/- 434 U/l. In addition to two pts. who already had a pacemaker implanted, two more (18%) who both had pre-existing left bundle branch block were pacemaker-dependent after PTSMA. During follow-up, 9 pts. (81%) reported significant and stable improvement. Two pts. (18%) developed progressive class III symptoms until their last follow-up, one of these together with persistent AF and a non-fatal stroke, the other received an ICD for primary prophylaxis and entered our pre-transplant program. Echo-Doppler showed sustained LVOTO elimination without global LV dilatation in all cases.


CONCLUSIONS
PTSMA is an effective non-surgical option for treating symptoms and residual or recurrent LVOTO after a previous surgical myectomy. The high rate of conduction disturbances in this post-surgical cohort translated into a higher rate of pacemaker dependency after PTSMA.
Faber
Lothar
L
Department of Cardiology, Heart and Diabetes Center North-Rhine Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany. lfaber@hdz-nrw.de
Welge
Dirk
D
Hering
Detlef
D
Butz
Thomas
T
Oldenburg
Olaf
O
Seggewiss
Hubert
H
Horstkotte
Dieter
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000008:administration & dosage*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology / Q000601:surgery*
D000431:Ethanol
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