de Villarreal-Soto Juan Esteban, Oteo-Domínguez Juan Francisco, Martínez-López Daniel, Ríos-Rosado Elsa Carolina, Vera-Puente Beatriz, Olivo-Soto Jean Carlo, Arízaga-Arce Fernando, García-Pavía Pablo, Ospina Mosquera Víctor Manuel, Villar García Susana, García Suárez Jessica, Cavero Miguel Ángel, Martín-López Carlos Esteban, Forteza-Gil Alberto
Cardiac Surgery, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain.
Cardiology Department, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain.
Interdiscip Cardiovasc Thorac Surg. 2024 May 3;38(5). doi: 10.1093/icvts/ivae058.
Extended septal myectomy and alcohol septal ablation are 2 invasive treatments for hypertrophic obstructive cardiomyopathy. Our goal was to compare which of these techniques achieved a higher reduction in gradients, improvement in New York Heart Association (NYHA) functional class and reduction in medical treatment.
It is a single-centre observational and retrospective analysis. We used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. The odds ratio or coefficient along with the 95% confidence interval was estimated according to the group and adjusted for the corresponding preprocedural variables and EuroSCORE II.
A total of 78 patients underwent septal myectomy, and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced to a higher degree in comparison to ablation: 21.0 mmHg [P < 0.001, 95% confidence interval -30.7; -11.3], and 34.3 mmHg (P < 0.001, -49.1; -19.5) respectively. Those patients who received a myectomy had a lower probability of having moderate mitral regurgitation (odds ratio = 0.18, P = 0.054). Patients after septal myectomy were more likely to be NYHA functional class I (80.4%), whereas patients after ablation were more likely to be NYHA functional class III (48%). Both groups continued with beta-blocker therapy, but disopyramide could be discontinued after the myectomy in more cases (20%-36% vs 59%-1.3%; P < 0.001), and there was a tendency to discontinue calcium channel blockers (48%-16% vs 15.4-3.8%; P = 0.054).
After adjustment using preprocedural gradients and EuroSCORE II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation.
扩大性室间隔心肌切除术和酒精室间隔消融术是肥厚性梗阻性心肌病的两种侵入性治疗方法。我们的目标是比较这两种技术中哪一种能使压差降低更多、纽约心脏协会（NYHA）心功能分级得到更大改善以及药物治疗减少更多。
这是一项单中心观察性和回顾性分析。我们使用多变量回归分析来评估消融术/心肌切除术与不同结局之间的关联。根据分组估计比值比或系数以及95%置信区间，并针对相应的术前变量和欧洲心脏手术风险评估系统II（EuroSCORE II）进行调整。
共有78例患者接受了室间隔心肌切除术，25例患者接受了酒精室间隔消融术。与消融术相比，心肌切除术后的基础压差和乏氏动作压差降低程度更高：分别为21.0 mmHg[P < 0.001，95%置信区间 -30.7；-11.3]和34.3 mmHg（P < 0.001，-49.1；-19.5）。接受心肌切除术的患者发生中度二尖瓣反流的可能性较低（比值比 = 0.18，P = 0.054）。室间隔心肌切除术后的患者更可能处于NYHA心功能I级（80.4%），而消融术后的患者更可能处于NYHA心功能III级（48%）。两组均继续接受β受体阻滞剂治疗，但心肌切除术后更多患者可停用丙吡胺（20% - 36%对59% - 1.3%；P < 0.001），并且有停用钙通道阻滞剂的趋势（48% - 16%对15.4 - 3.8%；P = 0.054）。
在使用术前压差和EuroSCORE II进行调整后，与室间隔消融术相比，心肌切除术能使左心室流出道压差降低得更多。
