title: A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy.
abstract: OBJECTIVE
  The aim of this meta-analysis was to compare long-term outcomes after myectomy and alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM).
  
  
  BACKGROUND
  Surgical myectomy and ASA are both accepted treatment options for medical therapy-resistant obstructive HCM. Previous meta-analyses only evaluated short-term outcomes.
  
  
  METHODS
  A systematic review was conducted for eligible studies with a follow-up of at least 3 years. Primary outcomes were all-cause mortality and (aborted) sudden cardiac death (SCD). Secondary outcomes were periprocedural complications, left ventricular outflow tract gradient, and New York Heart Association functional class after ≥3 months, and reintervention. Pooled estimates were calculated using a random-effects meta-analysis.
  
  
  RESULTS
  Sixteen myectomy cohorts (n = 2,791; mean follow-up, 7.4 years) and 11 ASA cohorts (n = 2,013; mean follow-up, 6.2 years) were included. Long-term mortality was found to be similarly low after ASA (1.5% per year) compared with myectomy (1.4% per year, p = 0.78). The rate of (aborted) SCD, including appropriate implantable cardioverter defibrillator shocks, was 0.4% per year after ASA and 0.5% per year after myectomy (p = 0.47). Permanent pacemaker implantation was performed after ASA in 10% of the patients compared with 4.4% after myectomy (p < 0.001). Reintervention was performed in 7.7% of the patients who underwent ASA compared with 1.6% after myectomy (p = 0.001).
  
  
  CONCLUSIONS
  Long-term mortality and (aborted) SCD rates after ASA and myectomy are similarly low. Patients who undergo ASA have more than twice the risk of permanent pacemaker implantation and a 5 times higher risk of the need for additional septal reduction therapy compared with those who undergo myectomy.
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands. Electronic address: maxliebregts@gmail.com.
authors.forename: Max
authors.initials: M
authors.lastname: Liebregts
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Vriesendorp
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Bakhtawar K
authors.initials: BK
authors.lastname: Mahmoodi
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Michelle
authors.initials: M
authors.lastname: Michels
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D006348:Cardiac Surgical Procedures; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome
keywords: alcohol septal ablation; hypertrophic cardiomyopathy; myectomy; septal reduction therapy; sudden cardiac death