Clinical characteristics and outcomes of alcohol septal ablation in the era of transcatheter valve interventions

Catheter Cardiovasc Interv. 2024 May;103(6):1023-1034. doi: 10.1002/ccd.31051. Epub 2024 Apr 19.

Abstract

Background: The clinical efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) have been well-established; however, less is known about outcomes in patients undergoing preemptive ASA before transcatheter mitral valve replacement (TMVR).

Aims: The goal of this study is to characterize the procedural characteristics and examine the clinical outcomes of ASA in both HCM and pre-TMVR.

Methods: This retrospective study compared procedural characteristics and outcomes in patient who underwent ASA for HCM and TMVR.

Results: In total, 137 patients were included, 86 in the HCM group and 51 in the TMVR group. The intraventricular septal thickness (mean 1.8 vs. 1.2 cm; p < 0.0001) and the pre-ASA LVOT gradient (73.6 vs. 33.8 mmHg; p ≤ 0.001) were higher in the HCM group vs the TMVR group. The mean volume of ethanol injected was higher (mean 2.4 vs. 1.7 cc; p < 0.0001). The average neo-left ventricular outflow tract area increased significantly after ASA in the patients undergoing TMVR (99.2 ± 83.37 mm2 vs. 196.5 ± 114.55 mm2; p = <0.0001). The HCM group had a greater reduction in the LVOT gradient after ASA vs the TMVR group (49.3 vs. 18 mmHg; p = 0.0040). The primary composite endpoint was higher in the TMVR group versus the HCM group (50.9% vs. 25.6%; p = 0.0404) and had a higher incidence of new permanent pacemaker (PPM) (25.5% vs. 18.6%; p = 0.3402). The TMVR group had a higher rate of all-cause mortality (9.8% vs. 1.2%; p = 0.0268).

Conclusions: Preemptive ASA before TMVR was performed in patients with higher degree of clinical comorbidities, and correspondingly is associated with worse short-term clinical outcomes in comparison to ASA for HCM patients. ASA before TMVR enabled percutaneous mitral interventions in a small but significant minority of patients that would have otherwise been excluded. The degree of LVOT and neoLVOT area increase is significant and predictable.

Keywords: alcohol septal ablation; hypertrophic cardiomyopathy; transcatheter mitral valve replacement.

Publication types

  • Comparative Study

MeSH terms

  • Ablation Techniques* / adverse effects
  • Ablation Techniques* / mortality
  • Aged
  • Aged, 80 and over
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / instrumentation
  • Cardiac Catheterization* / mortality
  • Cardiomyopathy, Hypertrophic* / diagnostic imaging
  • Cardiomyopathy, Hypertrophic* / mortality
  • Cardiomyopathy, Hypertrophic* / physiopathology
  • Cardiomyopathy, Hypertrophic* / surgery
  • Cardiomyopathy, Hypertrophic* / therapy
  • Ethanol* / administration & dosage
  • Ethanol* / adverse effects
  • Female
  • Heart Septum / diagnostic imaging
  • Heart Septum / surgery
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / mortality
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / mortality
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery
  • Mitral Valve* / diagnostic imaging
  • Mitral Valve* / physiopathology
  • Mitral Valve* / surgery
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Ethanol