Gordon Fox • December 7, 2023
Septal myectomy and alcohol septal ablation: how safe and effective?

Background

A new meta-analysis ( Yokohama et al. 2023 ) on the comparative success and safety of the two methods of septal reduction therapy – alcohol septal ablation (ASA; https://4hcm.org/alcohol-septal-ablation/) and septal myectomy (SM; https://4hcm.org/myectomy/ ) – was just published in European Journal of Cardio-thoracic Surgery.

Methods

Yujiro Yokoyama and colleagues conducted a meta-analysis of studies that compared both techniques. They focused primarily on all-cause mortality with at least one year follow-up. Secondary outcomes they studied included permanent pacemaker implantations, 30-day mortality, cardiovascular mortality ≥1 year of follow-up, reduction in left ventricular pressure gradient, repeat operations for left ventricular obstruction, strokes, and rehospitalizations due to heart failure. The review included 27 studies, with over 6000 ASAs and over 9000 SMs.

Results: mortality

All-cause mortality was similar for the two methods at one-year. However, in the subset of studies that followed up patients for at least five years, the all-cause mortality was increased among ASA patients, with an increased risk of about 20%.

Results: efficacy and complications

ASA was associated with less reduction of the left ventricular pressure gradient (on average, about 11 mmHg less reduction). The chance of a patient needing a second ASA or SM was about 9 times greater for ASA than for SM. There were no significant differences between treatments in risk of stroke or hospitalization due to heart failure.

Last words

Septal myectomy is regarded as the “gold standard” for treating obstruction. ASA is recommended mainly for those who would be poor surgical candidates.

Literature cited

Y. Yokohama, et al. 2023. Alcohol septal ablation versus surgical septal myectomy of obstructive hypertrophic cardiomyopathy: systematic review and meta-analysis, _European Journal of Cardio-Thoracic Surgery, Volume 63, Issue 3, March 2023, ezad043, https://doi.org/10.1093/ejcts/ezad043

HCMA Blog

Medical Management May

April 30, 2025
Medical Management means using medicines and other non-invasive therapies to relieve symptoms. It's exciting that new treatments for HCM are being studied and that the FDA approved Camzyos in 2022! HCM can cause various symptoms depending on how stiff the heart is, how much scarring (fibrosis) there is, and whether there is obstruction. Some people have no noticeable symptoms. Common symptoms are chest pain/pressure, shortness of breath, lightheadedness, fatigue, palpitations, and brain fog. Syncope (fainting) is dramatic but not as common as the other symptoms. Medications are the first-line treatment for symptoms of HCM. If patients can't take one class of medication, they can try a medication from a different class. Here are some medications used to treat HCM and what they're for: Beta Blockers - make your heart beat slower and relax better. They allow the heart to fill more completely between beats. They can lower blood pressure and relieve symptoms. Calcium Channel Blockers - used to lower blood pressure and slow the heart rate. May reduce symptoms from obstruction in HCM. Myosin Inhibitors - cause the heart to beat with less force. They may reduce obstruction and septal thickness in some patients. Camzyos (mavacamten) is the first of this class of medication. For more information, click HERE . Antiarrhythmics - help to restore normal rhythm in the heart. Blood Thinners - anticoagulants and anti-platelets make it harder for blood to clot. They are prescribed to reduce the risk of stroke. This risk is higher in patients with afib, aflutter, and artificial heart valves. Diuretics , or "water pills," help the kidneys get rid of extra water and salt, reducing swelling in the body. Sodium Channel Blockers - may reduce gradient in obstructive HCM and can treat chest pain. Some also act as antiarrhythmics. Antibiotics - treat or prevent bacterial infections. In HCM, they may be given before dental work to prevent infective endocarditis. To learn more and see the side effects of these medications, click HERE .
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