title: The long-term outcomes of transcoronary ablation of septal hypertrophy compared to surgical myectomy in patients with symptomatic hypertrophic obstructive cardiomyopathy.
abstract: OBJECTIVE
  The aim of this study was to compare the long-term outcomes of transcoronary ablation of septal hypertrophy (TASH) with open surgical myomectomy (SM) in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
  
  
  METHODS
  We reviewed patients who underwent either procedure at our institution. The demographics, clinical outcomes, echocardiographic parameters, and complications were compared.
  
  
  RESULTS
  Seventy patients with HOCM were treated with either TASH (n = 47, 26 male) or SM (n = 23, 10 male). Compared to those treated with SM, patients undergoing TASH were older (57+/- 14.7 years versus 47 +/- 20.6 years, P = 0.021) and more symptomatic. A higher proportion of patients had syncope as a presenting feature in the TASH group compared to the SM group (57.5% vs. 17.4%, P = 0.002) respectively. They were also more likely to be in New York Heart Association (NYHA) class III/IV compared to the patients who underwent SM (85.1% vs. 39.1%; P < 0.001). Patients were followed for a mean period of 43 months (TASH) and 46 months (SM). Repeat procedures were more common in the TASH group (17% vs. 0%, P = 0.04) but mitral valve replacement was more common in the SM group (0% vs. 8.7%, P = 0.105). Symptom improvement, the rate of complications and all cause mortality rates were similar in both groups.
  
  
  CONCLUSIONS
  TASH compares favorably with surgical myectomy with regard to symptom resolution, rate of complications and mortality in a tertiary referral centre and should be seen as an attractive alternative to surgical myectomy in the appropriate patient population.
authors.affiliation: The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland, 4032, Australia; University of Queensland, Australia.
authors.forename: Himabindu
authors.initials: H
authors.lastname: Samardhi
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.forename: Christopher
authors.initials: C
authors.lastname: Raffel
authors.forename: Shruti
authors.initials: S
authors.lastname: Rateesh
authors.forename: Catherine
authors.initials: C
authors.lastname: Harley
authors.forename: Darryl
authors.initials: D
authors.lastname: Burstow
authors.forename: Peter
authors.initials: P
authors.lastname: Pohlner
authors.forename: Con
authors.initials: C
authors.lastname: Aroney
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013575:Syncope / Q000209:etiology; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left
chemical_list: D000431:Ethanol
keywords: ANGO; HCM; septal ablation