Abstract 20042: Comparison Between Alcohol Septal Ablation and Myomectomy for Hypertrophic Obstructive Cardiomyopahty: A Meta-Analysis
Introduction: Both myomectomy and alcohol septal ablation (ASA) are used to treat patients with symptomatic hypertrophic obstructive cardiolmyopathy (HOCM). There is limited evidence to guide decision making between the two. Our aim was to compare the clinical and procedural outcomes among septal ablation and surgical myomectomy in patients with HOCM.
Methods: We systematically searched PubMed, EMBASE, and Cochrane for studies comparing septal ablation to surgical myomectomy between January 1966 and June 2014. Primary end-point was 30 day mortality. Secondary end-points were long-term mortality (>12 months), and peak LVOT gradient reduction. We used RevMan 5.1.7 software. Heterogeneity was defined as I2 values > 25%.
Results: A total of 11 observational and case-control studies were included and provided a total of 1155 patients. Myomectomy group was younger than septal ablation (9.37± 4 years; p<0.01).There was no difference in 30 day mortality between septal ablation and surgical myomectomy 1.7% vs. 1.4% (95% CI: 0.39-2.57;p=0.99) (Figure A). There was no difference on long term mortality among groups (5.9% vs. 5.3%; 95% CI: 0.47-1.98; p=0.92) (Figure B). There was a significant 64.43% reduction of LVOT gradient in SA group and 71.03% in the surgical groups (p<0.01) respectively (Figures C,D).
Conclusion: Patients undergoing myomectomy are significantly younger than those having ASA. Short and long term mortality were similar. Clinical and anatomical features favoring one or the other strategy were not captured by our analysis. Further studies are required to resolve clinical equipoise.
Author Disclosures: D. Garcia: None. M. Mehdi Ansari: None. R. Nascimento: None. C. Alfonso: None. A. Heldman: None.
- © 2014 by American Heart Association, Inc.