title: A meta analysis of current status of alcohol septal ablation and surgical myectomy for obstructive hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  Our objective was to perform an updated systematic review to compare the efficacy and short- and long-term mortality of surgical myectomy (SM) and alcohol septal ablation (ASA) by including most recent and largest cohort studies published in last few years.
  
  
  BACKGROUND
  SM and ASA are the two invasive strategies used to relieve left ventricular outflow tract obstruction (LVOTO) in patients with drug refractory symptomatic hypertrophic cardiomyopathy (HCM). In the absence of a randomized trial, we tried to compare the pros and cons of the two procedures using a systematic review and meta-analysis.
  
  
  METHODS
  A comprehensive search of three major databases was performed. We included original research studies comparing data on ASA and SM. Of 1,143 citations, 10 studies were included in the analysis.
  
  
  RESULTS
  A total of 805 patients underwent ASA and 1,019 underwent SM. Patients undergoing SM were younger (MD 6.3, P = 0.0001) and had higher reduction in the LVOT gradient (MD -9.56, P = 0.05). However, there was similar resolution of class III and IV symptoms between the two groups (P = 0.56). There was no difference in sudden cardiac death (SCD) (P = 0.93), short-term (P = 0.36), long-term all cause (P = 0.27), and long-term cardiac mortality (P = 0.58). Patients undergoing ASA had higher incidence of post procedure device implantation (OR 3.09, P < 0.00001).
  
  
  CONCLUSIONS
  No significant difference in symptom relief was noted between the two approaches. ASA was as safe a myectomy with regards to SCD, short-term, and long-term mortality. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 1J7, Canada.|Department of Cardiology, Basil Hetzel Institution, University of Adelaide, SA, 5000, Australia.
authors.forename: Kuljit
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 1J7, Canada.|Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Qutub
authors.affiliation: Department of Cardiology, Basil Hetzel Institution, University of Adelaide, SA, 5000, Australia.
authors.forename: Kristin
authors.initials: K
authors.lastname: Carson
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 1J7, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 1J7, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Glover
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
chemical_list: D000431:Ethanol
keywords: alcohol septal ablation; hypertrophic cardiomyopathy; septal myectomy