Vol. 20 No. 3 (2016)
ACQUIRED HEART DISEASES

Assessment of safety and efficacy of Morrow septal myectomy and alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: the results of a pilot randomized trial

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  • R Naydenov,
  • E Kretov,
  • V Baystrukov,
  • O Krestyaninov,
  • R Ibragimov,
  • A Prokhorikhin,
  • I Naryshkin,
  • D Zubarev,
  • N Obedinskaya,
  • A Biryukov,
  • E Pokushalov,
  • A Romanov
R Naydenov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
E Kretov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
V Baystrukov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
O Krestyaninov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
R Ibragimov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
A Prokhorikhin
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
I Naryshkin
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
D Zubarev
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
N Obedinskaya
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
A Biryukov
Pavlov First Saint Petersburg State Medical University, Ministry of Health Care of Russian Federation, 197022 Saint Petersburg, Russian Federation
Bio
E Pokushalov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
A Romanov
Research Institute of Circulation Pathology, 630055 Novosibirsk, Russian Federation
Bio
DOI: https://doi.org/10.21688/1681-3472-2016-3-42-53

Published 2016-11-10

Keywords

  • obstructive hypertrophic cardiomyopathy,
  • septal myectomy,
  • alcohol septal ablation,
  • LVOT gradient,
  • complications,
  • reduced volume of infarction
    • ...More
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How to Cite

Naydenov, R., Kretov, E., Baystrukov, V., Krestyaninov, O., Ibragimov, R., Prokhorikhin, A., Naryshkin, I., Zubarev, D., Obedinskaya, N., Biryukov, A., Pokushalov, E., & Romanov, A. (2016). Assessment of safety and efficacy of Morrow septal myectomy and alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: the results of a pilot randomized trial. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(3), 42–53. https://doi.org/10.21688/1681-3472-2016-3-42-53

Copyright (c) 2016 Naydenov R.A., Kretov E.I., Baystrukov V.I., Krestyaninov O.V., Ibragimov R.U., Prokhorikhin A.A., Naryshkin I.E., Zubarev D.D., Obedinskaya N.R., Biryukov A.V., Pokushalov E.A., Romanov A.B.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. The aim of this randomized study was to evaluate the safety and efficacy of septal myectomy (SM) and alcohol septal ablation (ASA) in patients with an obstructive form of hypertrophic cardiomyopathy.
Methods. The study included 76 patients eligible for ASA and Morrow myectomy. The patients were divided into two equal groups: one for ASA (n = 38), the other for SM.
The primary endpoint (combined) was to assess the safety, which included 30-day complications after surgery (mortality, bleeding, tamponade, stroke, development of VT / VF) and the frequency of pacemaker/ICD implantation.
Secondary endpoints focused on the evaluation of pressure gradient (efficiency), repeated operations, clinical and functional indicators, volume and mass of the ablation zone and dissected infarction. Control observation period was 12 months.
Results. By the end of control observations, it was found out that SM is a safer technique as compared to ASA, the complication rate was 13 % and 47 % respectively (log-rank test p = 0.0021; Cox: HR 11.4 95% CI [1.52 -11.1] p = 0.005). No significant differences in early (30 days) postoperative complications were found (log-rank test p = 0.24; Cox: HR 2.52, 95% CI [0.48-12.9] p = 0.27). Rhythm disturbances requiring pacemaker implantation / ICD (log-rank test p = 0.0029; Cox: HR 95% CI 4.92 [1.06-22.74] p = 0.042) were the most common complication. In both groups, there was a significant reduction of the LVOT gradient, p <0.01. However, the residual gradient in the ASA group was significantly higher than that in the SM group, p <0.01. Clinical data of both groups were comparable in the long term. A significant correlation was observed between the dissected infarction volume and the degree of reduction in the LVOT gradient of the SM group, p = 0.01. No significant dependency of the ablation zone volume on the degree of reduction in the LVOT gradient was observed, p = 0.7.
Conclusion. Septal myectomy is a safe treatment for hypertrophic cardiomyopathy as compared to ASA. Alcohol septal ablation and SM are comparable in the effectiveness of LVOT gradient reduction. There is a dependence of the excised myocardium volume and the degree of reduction in the LVOT gradient during long-term follow-up of patients who underwent Morrow SM.

Received 5 August 2016. Accepted 2 September 2016.

Funding: The study had no sponsorship.
Conflict of interest: The authors declare no conflict of interest.

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References

  1. Osiev AG, Naydenov RA, Kretov EI, Obedinskaya NR, Kurbatov VP. Hypertrophic obstructive cardiomyopathy. Almanac of Clinical Medicine. 2015;38:95-104.
  2. Osiyev AG, Mironenko SP, Kretov YeI, Grankin DS, Maletina IV, Malahova OY, Biriukov AV, Zubarev DD. The immediate results of transcoronary septal ablation at broadening the patients with hypertrophic cardiomyopathy. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2010;1:38-40. (In Russ.)
  3. Masry HE, Breall JA. Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Circ Cardiovasc Interv. 2008;4(3):193-7. DOI: 10.2174/157340308785160561
  4. Authors/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy. European Heart Journal. 2014;35(39):2733-79. DOI: 10.1093/eurheartj/ehu284
  5. Leonardi RA, Kransdorf EP, Simel DL, Wang A. Meta-Analyses of septal reduction therapies for obstructive hypertrophic cardiomyopathy comparative rates of overall mortality and sudden cardiac death after treatment. Circ Cardiovasc Interv. 2010;3(2):97-104. DOI: 10.1161/CIRCINTERVENTIONS.109.916676
  6. Sorajja P, Ommen SR, Holmes DR Jr, Dearani JA, Rihal CS, Gersh BJ, Lennon RJ, Nishimura R.A. Survival after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2012;126(20):2374-80. DOI: 10.1161/CIRCULATIONAHA.111.076257
  7. Jensen MK, Prinz C, Horstkotte D, van Buuren F, Bitter T, Faber L, Bundgaard H, Alcohol septal ablation in patients with hypertrophicobstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile. Heart. 2013;99(14):1012-7. DOI: 10.1136/heartjnl-2012-303339
  8. Sedehi D, Finocchiaro G, Tibayan Y, Chi J, Pavlovic A, Kim YM, Tibayan FA, Reitz BA, Robbins RC, Woo J, Ha R, Lee DP, Ashley EA. Long-term outcomes of septal reduction for obstructive hypertrophic cardiomyopathy. J Cardiol. 2015;66(1):57-62. DOI: 10.1016/j.jjcc.2014.08.010
  9. Osiev AG, Kretov EI, Naydenov RA, Kurbatov VP, Mironenko SP, Artamonova EA, Malakhova OYu. Endovaskulyarnaya khirurgiya. 2014;1(1):63-7. (In Russ.)
  10. Osiev AG, Kretov YeI, Kurbatov VP, Mironenko SP, Naydenov RA, Artamonova YeA, Malakhova OYu. A new approach to the assessment of outcomes of alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2013:17(3):46-9. (In Russ.)
  11. Богачев-Прокофьев А.В., Железнев С.И., Фоменко М.С., Афанасьев А.В., Шарифулин Р.М., Пивкин А.Н., Демидов Д.П., Караськов А.М. Первый опыт расширенной миоэктомии при хирургическом лечении обструктивной гипертрофической кардиомиопатии: непосредственные и промежуточные результаты. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;19(2):20-5. (In Russ.)
  12. Karaskov AM, Osiev AG. Gipertroficheskaya kardiomiopatiya s obstruktsiey vykhodnogo otdela levogo zheludochka. Novosibirsk; 2012. 187 p. (In Russ.)
  13. Dearani JA, Ommen SR, Gersh BJ, Schaff HV, Danielson GK. Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy Mayo Clinic: Septal Myectomy: Long-term Results. Nat Clin Pract Cardiovasc Med. 2007;4(9):503-12. DOI: 10.1038/ncpcardio0965