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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
Interdisciplinary cardiovascular and thoracic surgery, 05/2024, Letnik: 38, Številka: 5Journal Article
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.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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