Abstract 1782: Alcohol Septal Ablation in Symptomatic Patients with Hypertophic Cardiomyopathy at High-Risk for Surgical Myectomy: Data on Long-term Outcomes
Introduction: Surgical myectomy has excellent long-term outcomes and is preferred treatment in symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients, without significant co-morbidities. At our institution, we typically perform alcohol septal ablation (ASA) in symptomatic HOCM patients at high risk for surgery. We sought to assess long-term outcomes of ASA in such high-risk patients.
Methods: We studied 56 consecutive symptomatic HOCM patients (mean age 62 ± 13 years, 66 % women, mean follow up 8 ± 1 years), at high-risk for surgery (due to age/co-morbidities) who had ASA between1997–2000. Following were recorded at baseline and 3 months: septal thickness, resting and provokable left ventricular outflow tract (LVOT) gradient, degree (0–4 +) of mitral regurgitation (MR), Minnesota quality of life (MQOL) score and presence of pacemaker (PM). All-cause mortality was recorded.
Results: Mean resting LVOT gradient (70 ± 44 vs. 26 ± 27 mm Hg), provokable LVOT gradient (108 ± 41 vs. 46 ± 37 mm Hg), septal thickness (2.4 ± 0.4 vs. 1.8 ± 0.6 cm), MR (2.2 ± 1 vs. 1.5 ± 1) and MQOL score (63 vs. 25) improved at 3 months, compared to baseline (all p < 0.001). New PM was present in 26 % patients at 3 months. No patients died at 48 hours, 2 at 1 year, 7 at 5 years and 12 at 10-years. Only age > 65 years at time of ASA predicted long term survival (p = 0.03, Figure⇓).
Conclusion: In symptomatic HOCM patients at high-risk for surgery, ASA is associated with significant improvement in LVOT gradient, MR and MQOL score at 3 months. Short-term mortality is low and long-term mortality is associated with older age at the time of ASA. In symptomatic HOCM patients at high-risk for surgical myectomy, ASA is a viable option.