Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russia.
Catheterization Laboratory, Sverdlovsk Regional Hospital #1, Yekaterinburg, Russia.
Interact Cardiovasc Thorac Surg. 2020 Aug 1;31(2):158-165. doi: 10.1093/icvts/ivaa075.
There is very little evidence comparing the safety and efficacy of alcohol septal ablation versus septal myectomy for a septal reduction in patients with hypertrophic obstructive cardiomyopathy. This study aimed to compare the immediate and long-term outcomes of these procedures.
Following propensity score matching, we retrospectively analysed outcomes in 105 patients who underwent myectomy and 105 who underwent septal ablation between 2011 and 2017 at 2 reference centres.
The mean age was 51.9 ± 14.3 and 52.2 ± 14.3 years in the myectomy and ablation groups, respectively (P = 0.855), and postoperative left ventricular outflow tract gradients were 13 (10-19) mmHg vs 16 (12-26) mmHg; P = 0.025. The 1-year prevalence of the New York Heart Association class III-IV was higher in the ablation group (none vs 6.4%; P = 0.041). The 5-year overall survival rate [96.8% (86.3-99.3) after myectomy and 93.5% (85.9-97.1) after ablation; P = 0.103] and cumulative incidence of sudden cardiac death [0% and 1.9% (0.5-7.5), respectively P = 0.797] did not differ between the groups. The cumulative reoperation rate within 5 years was lower after myectomy than after ablation [2.0% (0.5-7.6) vs 14.6% (8.6-24.1); P = 0.003]. Ablation was associated with a higher reoperation risk (subdistributional hazard ratio = 5.9; 95% confidence interval 1.3-26.3, P = 0.020). At follow-up, left ventricular outflow tract gradient [16 (11-20) vs 23 (15-59) mmHg; P < 0.001] and prevalence of 2+ mitral regurgitation (1.1% vs 10.6%; P = 0.016) were lower after myectomy than after ablation.
Both procedures improved functional capacity; however, myectomy better-resolved classes III-IV of heart failure. Septal ablation was associated with higher reoperation rates. Myectomy demonstrated benefits in gradient relief and mitral regurgitation elimination. The results suggest that decreasing rates of myectomy procedures need to be investigated and reconsidered.
在肥厚型梗阻性心肌病患者中，行酒精室间隔消融术与行室间隔心肌切除术以减少室间隔厚度的安全性和疗效比较的证据非常有限。本研究旨在比较这两种手术的即刻和长期结果。
通过倾向评分匹配，我们回顾性分析了 2011 年至 2017 年在 2 个参考中心接受心肌切除术和 105 例接受室间隔消融术的 105 例患者的结果。
心肌切除术组和消融组的平均年龄分别为 51.9±14.3 岁和 52.2±14.3 岁（P=0.855），术后左心室流出道梯度分别为 13（10-19）mmHg 和 16（12-26）mmHg；P=0.025。消融组的 1 年纽约心脏协会心功能分级 III-IV 发生率更高（无 vs 6.4%；P=0.041）。5 年总生存率[心肌切除术组为 96.8%（86.3-99.3），消融组为 93.5%（85.9-97.1）；P=0.103]和累积性心源性猝死发生率[0%和 1.9%（0.5-7.5），P=0.797]在两组之间无差异。5 年内再次手术率在心肌切除术组低于消融组[2.0%（0.5-7.6）比 14.6%（8.6-24.1）；P=0.003]。消融术与较高的再手术风险相关（亚分布风险比=5.9；95%置信区间 1.3-26.3，P=0.020）。随访时，心肌切除术组的左心室流出道梯度[16（11-20）mmHg 比 23（15-59）mmHg；P<0.001]和 2+二尖瓣反流发生率（1.1%比 10.6%；P=0.016）低于消融组。
两种手术都改善了心功能，但心肌切除术能更好地改善 III-IV 级心力衰竭。室间隔消融术与较高的再手术率相关。心肌切除术在缓解梯度和消除二尖瓣反流方面有获益。这些结果表明，需要研究和重新考虑减少心肌切除术的比率。
