title: Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification.
abstract: OBJECTIVE
  To evaluate the outcomes of the early experience of percutaneous alcohol septal ablation in patients with severe left ventricular outflow tract (LVOT) obstruction post transcatheter mitral valve replacement (TMVR).
  
  
  BACKGROUND
  Severe LVOT obstruction with hemodynamic compromise is a complication of TMVR associated with high mortality. Percutaneous alcohol septal ablation has recently been described as a therapeutic option in this setting.
  
  
  METHODS
  Multicenter retrospective review of clinical outcomes of patients undergoing alcohol septal ablation to treat LVOT obstruction after TMVR for severe mitral stenosis with severe mitral annular calcification.
  
  
  RESULTS
  Six patients underwent percutaneous alcohol septal ablation to treat LVOT obstruction post-TMVR at six different centers. Five patients had immediate significant reduction in LVOT obstruction with improvement in hemodynamic status while one had persistent LVOT gradient but hemodynamic instability improved. The first patient died on postoperative day 4 due to complete heart block. One patient had initial improvement in LVOT gradient with recurrence on postoperative day 1 thought to be secondary to septal edema, was treated with surgical removal of the transcatheter valve and resection of the anterior mitral leaflet followed by transatrial TMVR and died 3 weeks later due to multi-organ failure. The remaining four patients improved clinically after alcohol septal ablation, were discharged from the hospital and were clinically stable at 30-day follow-up.
  
  
  CONCLUSIONS
  Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT obstruction when septal hypertrophy is a contributing factor. This may be a safer alternative to bail-out surgery in this extremely high-risk patient population. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine, Division of Cardiology, Evanston Hospital, Evanston, Illinois.
authors.forename: Mayra
authors.identifier: http://orcid.org/0000-0002-9151-8096
authors.initials: M
authors.lastname: Guerrero
authors.affiliation: Department of Medicine Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Dee Dee
authors.initials: DD
authors.lastname: Wang
authors.affiliation: Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Department of Medicine, Division of Cardiology, Evanston Hospital, Evanston, Illinois.
authors.forename: Amit
authors.initials: A
authors.lastname: Pursnani
authors.affiliation: Division of Cardiology, Cooper University Hospital, Camden, New Jersey.
authors.forename: Georges
authors.initials: G
authors.lastname: Kaddissi
authors.affiliation: Division of Cardiology, Buffalo General Medical Center, Buffalo New York.
authors.forename: Vijay
authors.initials: V
authors.lastname: Iyer
authors.affiliation: Department of Medicine, Division of Cardiology, Evanston Hospital, Evanston, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Salinger
authors.affiliation: Department of Medicine, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Department of Medicine Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Adam
authors.initials: A
authors.lastname: Greenbaum
authors.affiliation: Department of Medicine, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Department of Medicine, Division of Cardiology, Evanston Hospital, Evanston, Illinois.
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Department of Medicine Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D000431:Ethanol
keywords: alcohol septal ablation; calcific mitral stenosis; left ventricular outflow tract obstruction; mitral annular calcification; mitral valve disease; transcatheter mitral valve replacement