Extended septal myectomy versus Alcohol septal ablation. Clinical results in a national referral center.

Extended septal myectomy and alcohol septal ablation are two invasive treatments for hypertrophic obstructive cardiomyopathy. We aim to compare which of these techniques achieves a higher reduction in gradients, improvement in NYHA class and reduction in medical treatment. This is a single-center observational and retrospective analysis. This is a single-center observational and retrospective analysis. We have used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. Odds ratio or coefficient along with the 95% confidence interval were estimated according to the group, and adjusting for the corresponding pre procedural variables and Euroscore II. 78 patients underwent septal myectomy and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced in a higher degree in comparison to ablation, 21.0 mmHg (p < 0.001, 95%CI -30.7; -11.3), and 34.3 mmHg (p < 0.001, -49.1; -19.5) respectively. Those patients who received myectomy had lower probability of presenting moderate mitral regurgitation (OR = 0.18, p = 0.054). Patients after septal myectomy were more likely to be in NYHA I (80.4%); whilst patients after ablation were more likely to be NYHA III (48%). Both groups continued with betablocker therapy, but disopyramide could be discontinued after myectomy in more cases (20% - 36% vs. 59% - 1.3%; p < 0.001) and there is a tendency in the discontinuation of calcium channel blockers (48% - 16% vs. 15.4-3.8%; p = 0.054). After adjustment by pre procedural gradients and Euroscore II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.