Alam Mahboob, Dokainish Hisham, Lakkis Nasser
Baylor College of Medicine-Cardiology, Houston, Texas 77030, USA.
J Interv Cardiol. 2006 Aug;19(4):319-27. doi: 10.1111/j.1540-8183.2006.00153.x.
Alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) has emerged as a lesser invasive alternative to surgical myectomy over the past decade. The purpose of this study is to analyze all the published literature on outcomes and complications after ASA.
MEDLINE and PubMed were searched for all available published literature on ASA (June 1996-June 2005) using the terms hypertrophic obstructive cardiomyopathy (HOCM), alcohol septal ablation for hypertrophic obstructive cardiomyopathy, alcohol septal ablation for HOCM, alcohol septal ablation (ASA), transcoronary alcohol septal ablation for hypertrophic obstructive cardiomyopathy (TASH), transcoronary alcohol septal ablation for HOCM, nonsurgical septal reduction therapy (NSRT), and percutaneous transcoronary septal myocardial ablation (PTSMA).
A total of 42 published studies (2,959 patients) were analyzed. Mean age was 53.5 (35.4-72) years with a mean male to female ratio of 1.17. Mean follow-up was 12.7 +/- 0.3 months (1.5-43.2). Absolute ethanol (3 mL) was injected in 1.2 septal perforator arteries. On average, serum CK peaked at 964 units. At 12 months, there was a sustained decrease in resting and provoked LVOT gradient (65.3-15.8 and 125.4-31.5 mmHg, respectively) accompanied by reduction in basal septal diameter (20.9-13.9 mm), improvement in NYHA Class (2.9-1.2), and increase in exercise capacity (325.3-437.5 seconds). Early mortality (within 30 days) was 1.5% (0.0-5.0%) and late mortality (beyond 30 days) was 0.5% (0.0-9.3%). Other complications include ventricular fibrillation (2.2%), LAD dissection (1.8%), complete heart block requiring permanent pacemaker (10.5%), and pericardial effusion (0.6%). A repeat ASA was performed on 6.6% of patients and 1.9% of patients underwent surgical myomectomy with resolution of symptoms.
Literature to date suggests that ASA results in acute and intermediate-term favorable clinical and echocardiographic outcomes. A randomized controlled trial is needed to compare ASA and myomectomy in order to determine which technique provides maximal benefit.
在过去十年中，酒精间隔消融术（ASA）治疗肥厚性梗阻性心肌病（HOCM）已成为一种侵入性较小的替代外科心肌切除术的方法。本研究的目的是分析所有已发表的关于ASA术后结局和并发症的文献。
使用术语肥厚性梗阻性心肌病（HOCM）、肥厚性梗阻性心肌病的酒精间隔消融术、HOCM的酒精间隔消融术、酒精间隔消融术（ASA）、肥厚性梗阻性心肌病的经冠状动脉酒精间隔消融术（TASH）、HOCM的经冠状动脉酒精间隔消融术、非手术性间隔减容治疗（NSRT）以及经皮经冠状动脉间隔心肌消融术（PTSMA），在MEDLINE和PubMed中检索1996年6月至2005年6月期间所有关于ASA的已发表文献。
共分析了42项已发表研究（2959例患者）。平均年龄为53.5（35.4 - 72）岁，平均男女比例为1.17。平均随访时间为12.7±0.3个月（1.5 - 43.2个月）。向1.2支间隔穿支动脉注射无水乙醇（3 mL）。平均而言，血清肌酸激酶（CK）峰值为964单位。在12个月时，静息和激发状态下的左心室流出道（LVOT）压差持续下降（分别从65.3降至15.8 mmHg和从125.4降至31.5 mmHg），同时基底间隔直径减小（从20.9降至13.9 mm），纽约心脏协会（NYHA）心功能分级改善（从2.9降至1.2），运动能力增加（从325.3秒增至437.5秒）。早期死亡率（30天内）为1.5%（0.0 - 5.0%），晚期死亡率（30天后）为0.5%（0.0 - 9.3%）。其他并发症包括室颤（2.2%）、左前降支（LAD）夹层（1.8%）、需要永久起搏器的完全性心脏传导阻滞（10.5%）以及心包积液（0.6%）。6.6%的患者接受了重复ASA，1.9%的患者接受了外科心肌切除术，症状得到缓解。
迄今为止的文献表明，ASA可带来急性和中期良好的临床及超声心动图结局。需要进行一项随机对照试验来比较ASA和心肌切除术，以确定哪种技术能提供最大益处。
