title: Short and long-term outcomes of alcohol septal ablation with the trans-radial versus the trans-femoral approach: A single center-experience.
abstract: BACKGROUND
  Although the trans-radial approach (TR) has been applied to various subsets of patients in percutaneous coronary intervention, the feasibility, efficacy, acute procedural and long-term outcomes of TR versus trans-femoral approach (TF) for alcohol septal ablation (ASA) have not yet been determined.
  
  
  OBJECTIVE
  The aim of this study was to compare the short and long-term outcomes of ASA with the TR approach compared to the TF approach.
  
  
  METHODS
  We retrospectively analyzed 240 patients who underwent an ASA procedure at our institution from November 1999 to November 2015. The TR approach was performed in 172 cases and the TF approach in the remaining 68 cases.
  
  
  RESULTS
  The use of TR approach progressively increased from 62% in 1999-2005 to 91% in 2011-2015 (p=0.0001). The TF and TR group had similar age, baseline NYHA class (NYHA 3 or 4) and mean left ventricular outflow tract peak gradient before ASA. Total contrast used (TR: 73.2±47.2ml; TF: 88.7±49.3ml, p=0.11), total radiation Air kerma area product (TR: 43.7±48.0Gycm(-2); TF: 55.9±48.2Gycm(-2); p=0.39) and peak left ventricular outflow tract gradient immediately after ASA (TR: 19.1±19.6mmHg; TF: 20.4±18.0mmHg, p=0.63) were similar in both groups. Procedural success was 91.9% and 91.2% in the TR and TF groups, respectively (p=0.53). At 30days, there was 2 intra-hospital death (1 in TF and 1 in TR), 1 major stroke in the TF group and 1 coronary artery dissection in the TR group. Vascular complications were less frequent in the TR group (0.58% vs. 7.3%; p=0.002). The mean length of follow-up was 4.56±4.34years (IQR 0.69-8.2; median 2.92years; maximum: 15.5years). By Kaplan-Meier estimate, the observed survival in the overall cohort was comparable to the expected survival for a sex and age-matched comparable general French population at 10years (86.9 vs. 83.6%, p=0.88). Survival was similar between the TR and TF group (92.1% vs. 89.7% at 6years, respectively; p=0.71).
  
  
  CONCLUSIONS
  Alcohol septal ablation from the radial approach can be performed with similar acute and long-term success, but with lower vascular complications compared to the femoral approach.
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Fadi J
authors.initials: FJ
authors.lastname: Sawaya
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Spaziano
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Hage
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Carlos
authors.initials: C
authors.lastname: El-Khoury
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Andrew
authors.initials: A
authors.lastname: Roy
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Unterseeh
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Champagne
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Piechaud
authors.affiliation: Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.affiliation: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France. Electronic address: t.lefevre@angio-icps.com.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: Alcohol septal ablation; Death; Trans-femoral; Trans-radial; Vascular complications