Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
Am J Cardiol. 2023 Aug 15;201:116-122. doi: 10.1016/j.amjcard.2023.06.006. Epub 2023 Jun 23.
Alcohol septal ablation is an established treatment for selected patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction (LVOT). The safety and efficacy of septal microsphere embolization (SME) have not been studied. We conducted a retrospective analysis of SME procedures performed at our center from 2006 to 2021 using 75-µm microspheres. The primary end point was LVOT gradient reduction. Secondary outcomes included periprocedural mortality, conduction disturbances, access site complications, and duration of hospitalization. The population comprised 76 patients (median age 61 years, men 43%). Dyspnea New York Heart Association ≥III was present in 65 patients (86%); ventricular tachycardia and previous syncope were described in 4% and 18%, respectively. Median duration of hospitalization was 13 days, and the time to first follow-up was 4 months. SME resulted in a significant reduction at rest (41 vs 12 mm Hg, mean Δ PG = -71%, p <0.001) and provoked LVOT gradients (94 vs 29 mm Hg, mean Δ PG = -75%, p <0.001). Periprocedural death occurred in 1 patient (1%) who underwent SME after transcatheter aortic valve replacement. Complete atrioventricular block was observed in 5 patients (7%). Left bundle branch block was diagnosed in 1 case (1%) and right bundle branch block in 3 (4%). Access site complications were observed in 4 patients (5%). In conclusion, SME is a safe and effective alternative to alcohol septal ablation. The potential advantages of microspheres are still to be investigated in prospective studies.
酒精室间隔消融术是治疗特定肥厚型心肌病和左心室流出道梗阻（LVOT）患者的一种既定疗法。室间隔微球栓塞（SME）的安全性和疗效尚未得到研究。我们对 2006 年至 2021 年在我们中心进行的 SME 手术进行了回顾性分析，使用了 75-µm 微球。主要终点是 LVOT 梯度降低。次要结局包括围手术期死亡率、传导障碍、入路部位并发症和住院时间。该人群包括 76 例患者（中位年龄 61 岁，男性 43%）。65 例（86%）患者存在呼吸困难纽约心脏协会≥III 级；4%的患者描述有心律失常，18%的患者描述有晕厥史。中位住院时间为 13 天，首次随访时间为 4 个月。SME 导致静息时（41 对 12mmHg，平均ΔPG=-71%，p<0.001）和激发时的 LVOT 梯度显著降低（94 对 29mmHg，平均ΔPG=-75%，p<0.001）。1 例（1%）患者在经导管主动脉瓣置换术后接受 SME 治疗后死亡。5 例（7%）患者出现完全性房室传导阻滞。1 例（1%）诊断为左束支传导阻滞，3 例（4%）诊断为右束支传导阻滞。4 例（5%）患者出现入路部位并发症。总之，SME 是酒精室间隔消融术的一种安全有效的替代方法。微球的潜在优势仍有待前瞻性研究进一步探讨。
