ABSTRACT
While randomized comparative studies are lacking, currently available data suggest that septal ablation and surgical myectomy have similar short and mid-term success rates (Table 44.2). Postprocedurally, both modalities of septal reduction offer similar degrees of LVOT gradient reduction that appears to be durable up to one year after either procedure (30,37,42,45-48). Furthermore, at 6-and 12-month follow-up, both groups were found to have similar and sustained improvements in NYHA functional class, Canadian cardiovascular angina class, and a reduction in the number of syncopal and presyncopal events (30,42,49). However, both procedures have advantages as well as associated complications that further underscore the importance of exercising the utmost care with patient selection prior to choosing either intervention. A recent retrospective analysis of 601 patients with severely symptomatic, drug refractory HCM referred to the Mayo Clinic for catheter ablation found that alcohol septal ablation offered a four-year survival similar to that of age-and gender-matched patients who had undergone surgical myectomy but were noted to have a complication rate that was significantly greater than that of myectomy (50). In summary, either surgical myectomy or alcohol ablation may be considered as a primary treatment modality in symptomatic patients with LVOT obstruction after careful consideration of the patient’s clinical situation, anatomical characteristics, and institutional expertise.
