Follow-up of alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy the Baylor and Medical University of South Carolina experience 1996 to 2007.
OBJECTIVE
This study sought to determine the long-term outcome of alcohol septal ablation (ASA).


BACKGROUND
There are inadequate data on the long-term outcome of ASA for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).


METHODS
Six hundred and twenty-nine patients were enrolled consecutively (1996 to 2007) and 98.4% (n = 619) underwent ASA with 92% follow-up in 2007. Evaluation included deaths, procedural complications, pacemaker requirement, repeat ASA, and myectomy/valve surgery. Follow-up parameters included angina (Canadian Cardiovascular Society score), dyspnea (New York Heart Association functional class), exercise time, and echocardiographic indices (septal thickness, ejection fraction, resting and provoked gradients).


RESULTS
Ethanol (2.6 +/- 1.0 ml) was injected into 1.3 +/- 0.5 septal arteries, inducing a septal infarct. Complications included death 1% (n = 6), permanent pacemaker requirement 8.2% (n = 52), coronary dissection 1.3% (n = 8), and worsening mitral regurgitation 0.3% (n = 2). The mean follow-up was 4.6 +/- 2.5 years (range: 3 months to 10.2 years). During follow-up, New York Heart Association functional class decreased from 2.8 +/- 0.6 to 1.2 +/- 0.5 (p < 0.001); Canadian Cardiovascular Society angina score decreased from 2.1 +/- 0.9 to 1.0 +/- 0 (p < 0.001); and exercise time increased from 4.8 +/- 3.3 to 8.2 +/- 1.0 (p < 0.001) min. The resting and provoked left ventricular outflow tract gradients decreased progressively (p < 0.001) and remained low during follow-up. The septal thickness decreased from 2.1 +/- 0.5 cm to 1.0 +/- 0.1 cm (p < 0.001) and the ejection fraction decreased from 68 +/- 9% to 62 +/- 3% (p < 0.001). The survival estimates at 1, 5, and 8 years were 97%, 92%, and 89%, respectively.


CONCLUSIONS
The initial benefits of ASA were maintained during follow-up.
Fernandes
Valerian L
VL
Medical University of South Carolina, Charleston, 29425, USA.
Nielsen
Christopher
C
Nagueh
Sherif F
SF
Herrin
Amy E
AE
Slifka
Christine
C
Franklin
Jennifer
J
Spencer
William H
WH
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology / Q000628:therapy; D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects; D003323:Coronary Aneurysm / Q000209:etiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000008:administration & dosage*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000209:etiology / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007269:Injections, Intra-Arterial; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D013022:South Carolina; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D000431:Ethanol