Surgical Septal Myectomy for the Treatment of Residual Left Ventricular Outflow Tract Obstruction Following Failed Alcohol Septal Ablation.
Surgical Septal Myectomy for the Treatment of Residual Left Ventricular Outflow Tract Obstruction Following Failed Alcohol Septal Ablation.
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DOI：
10.1536/ihj.20-428
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发表时间：
2021-03
影响因子：
1.5
通讯作者：
Q. Ji;Yulin Wang;Ye Yang;H. Lai;W. Ding;L. Xia;Chunsheng Wang
中科院分区：
文献类型：
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作者：
Q. Ji;Yulin Wang;Ye Yang;H. Lai;W. Ding;L. Xia;Chunsheng Wang
酒精室间隔消融术 (ASA) 后残留左心室流出道 (LVOT) 梗阻的原因仍不清楚，ASA 失败后心肌切除术的结果仍然未被充分报道。 对 13 名在 ASA 失败后接受室间隔心肌切除术的有症状患者（10 名女性，中位年龄 60.0 岁）进行了回顾。对患者进行中位随访 6 个月。分析这些患者的临床特征和结局，并与同期在我院未接受ASA的178例接受孤立性心肌切除术的患者进行比较。 首次ASA手术中，注入的间隔穿支动脉中位数为1.0，消融后肌酸激酶峰值中位数为978.5 U/L。 消融和二尖瓣下引起的心肌梗死范围和位置无法控制分别在四名（30.8%）和七名（53.8%）患者中发现异常。没有发生手术或随访死亡。随访时中位最大 LVOT 梯度从术前 112.0 降至 8.5 mmHg（P < 0.001）。与对照组相比，ASA失败的患者二尖瓣下异常比例较高（53.8% vs 13.5%，P = 0.001），并且心肌切除术后完全性房室传导阻滞的发生率较高（15.4% vs 1.7%，P = 0.038）。二尖瓣下异常可能是 ASA 失败的原因。 ASA 失败后，通过手术治疗残余 LVOT 梗阻可能会获得良好的结果。
The reasons of residual left ventricular outflow tract (LVOT) obstruction following alcohol septal ablation (ASA) remain unclear, and outcomes of myectomy following failed ASA remain underreported.Thirteen symptomatic patients (10 women, a median age of 60.0 years) who underwent septal myectomy following failed ASA were reviewed. The patients were followed up for a median of 6 months. The clinical characteristics and outcomes of these patients were analyzed and were compared with those of 178 patients who underwent isolated myectomy without previous ASA at our institution during the same period.In the first ASA procedure, the median number of septal perforator arteries injected was 1.0 with the median value of peak creatine kinase following ablation of 978.5 U/L.Uncontrollable extent and location of infarcted myocardium caused by ablation and mitral subvalvular anomalies were found in four (30.8%) and seven (53.8%) patients, respectively. No operative or follow-up deaths occurred. The median maximum LVOT gradients fell from preoperative 112.0 to 8.5 mmHg at follow-up (P < 0.001). Compared with controls, patients with failed ASA had a higher proportion of mitral subvalvular anomalies (53.8% versus 13.5%, P = 0.001) and developed a higher incidence of complete atrioventricular block following myectomy (15.4% versus 1.7%, P = 0.038).Low institutional or operator experience with ablation, uncontrollable extent and location of infarcted myocardium caused by ablation, and mitral subvalvular anomalies may be reasons for failed ASA. Surgical myectomy for the treatment of residual LVOT obstruction after unsuccessful ASA may be associated with favorable results.