Author + information
- Alfonso Jurado-Román, MD, PhD∗ ( and )
- Jesús Piqueras Flores, MD, PhD
- ↵∗La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
We have read carefully the paper by Batzner et al. (1). We want to congratulate the investigators for the superb results obtained in a long-term follow-up. It is remarkable the meticulous strategy of alcohol septal ablation (ASA) in which only 1 septal branch per procedure is treated, and echocardiographic guidance is compulsory. Both issues should be generalized in order to standardize the procedure.
It is noteworthy the low mean age of the patients. As Fifer (2) describes, a lower age tends to be a factor that inclines the balance to surgical myectomy. However, these results (1), with a very low rate of cardiovascular complications at long-term follow-up, could presage the end of this tendency.
It has come to our attention that only 1.4% of patients were on disopiramide before ASA. It is also surprising the high rate of noncardiovascular deaths (71.4% of total deaths) (1) in a relatively young cohort. The investigators describe that the main cause was oncological, but in this age group, the risk of dying of cancer is lower than 22% (3). The high noncardiovascular mortality may cause long-term cardiovascular outcomes not to be fully evaluable.
It is interesting that the post-ASA reduction of gradient was <50%. We would like to know what the criteria were for considering a successful initial ASA and how many patients in which the first procedure was not satisfactory did not need a second one. It would also be interesting to know the evolution of left ventricular outflow tract gradient, mitral regurgitation, and ergospirometry data during follow-up. In our opinion, this paper highlights something of great importance: when ASA is performed in a protocolized manner, it is not inferior to myectomy. Furthermore, taking the precautions described by the investigators (1), its results will be generalizable to most centers. Thus, recommendation of ASA must be at the same level as myectomy regardless of age if there are no other conditions, because myectomy is very demanding, and very few surgical centers have enough experience with it.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2019 American College of Cardiology Foundation
- Batzner A.,
- Pfeiffer B.,
- Neugebauer A.,
- Aicha D.,
- Blank C.,
- Seggewiss H.
- Fifer M.A.
- White M.C.,
- Holman D.M.,
- Boehm J.E.,
- Peipins L.A.,
- Grossman M.,
- Henley S.J.