CLINICAL STUDY
Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy
Sherif F. Nagueh, MD, FACC*,*,
Steve R. Ommen, MD ,
Nasser M. Lakkis, MD, FACC*,
Donna Killip, RN*,
William A. Zoghbi, MD, FACC*,
Hartzell V. Schaff, MD, FACC,
Gordon K. Danielson, MD, FACC,
Miguel A. Quiñones, MD, FACC*,
A. J. Tajik, MD, FACC and
William H. Spencer, III, MD, FACC*
* Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
Divisions of Cardiology and Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received January 25, 2001;
revised manuscript received August 6, 2001,
accepted August 15, 2001.
* Reprint requests and correspondence: Dr. Sherif F. Nagueh, 6550 Fannin Street, SM-1246, Houston, Texas 77030-2717 USA
sherifn{at}bcm.tmc.edu
OBJECTIVES
This study was designed to compare the hemodynamic efficacy of nonsurgical septal reduction therapy (NSRT) by intracoronary ethanol with standard therapy (surgical myectomy) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM).
BACKGROUND
Nonsurgical septal reduction therapy has gained interest as a new treatment modality for patients with drug-refractory symptoms of HOCM; however, its benefits in comparison to surgery are unknown.
METHODS
Forty-one consecutive NSRT patients at Baylor College of Medicine with one-year follow-up were compared with age- and gradient-matched septal myectomy patients at the Mayo Clinic. All patients had left ventricular outflow obstruction with a resting gradient  40 mm Hg and none had concomitant procedures.
RESULTS
There were no baseline differences in New York Heart Association class, severity of mitral regurgitation, use of cardiac medications or exercise capacity. One death occurred during NSRT because of dissection of the left anterior descending artery. At one year, all improvements in both groups were similar. After surgical myectomy, more patients were on medications (p < 0.05) and there was a higher incidence of mild aortic regurgitation (p < 0.05). After NSRT, the incidence of pacemaker implantation for complete heart block was higher (22% vs. 2% in surgery; p = 0.02). However, seven of the nine pacemakers in the NSRT group were implanted before a modified ethanol injection technique and the use of contrast echocardiography.
CONCLUSIONS
Nonsurgical septal reduction therapy resulted in a significantly higher incidence of complete heart block, but the risk was reduced with contrast echocardiography and slow ethanol injection. Surgical myectomy resulted in a significantly higher incidence of mild aortic regurgitation. Nonsurgical septal reduction therapy, guided by contrast echocardiography, is an effective procedure for treating patients with HOCM. The hemodynamic and functional improvements at one year are similar to those of surgical myectomy.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | CCS | = Canadian Cardiovascular Society | | EDD | = end-diastolic dimension | | ESD | = end-systolic dimension | | HOCM | = hypertrophic obstructive cardiomyopathy | | ICD | = implantable cardiac defibrillator | | LVOT | = left ventricular outflow tract | | METS | = metabolic equivalents | | NSRT | = nonsurgical septal reduction therapy | | NYHA | = New York Heart Association | | VO2 peak | = maximal oxygen consumption |
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