Author + information
- Angelika Batzner, MD and
- Hubert Seggewiss, MD∗ ()
- ↵∗Kardiologie, Klinikum Wuerzburg Mitte, Standort Juliusspital, Juliuspromenade 19, 97070 Wuerzburg, Germany
We thank Drs. Jurado-Román and Flores for their comments on our publication about long-term survival after echo-guided alcohol septal ablation in hypertrophic obstructive cardiomyopathy (HOCM) (1). The reported results with a low number of acute complications and good long-term survival support our stepwise and standardized echo-guided procedure (percutaneous transluminal septal myocardial ablation [PTSMA]). Before we discuss this topic in more detail, we want to answer the points that Drs. Jurado-Román and Flores mentioned.
Although we are aware of the positive effect of disopyramide in HOCM, we have to explain that disopyramide is not available in Germany, where the large majority of the reported cohort lives and is insured.
Discussing the causes of deaths, we stated that patients with noncardiac deaths died mainly due to oncological reasons, but not all, because we also observed deaths from not–self-inflicted accident, suicide, pneumonia, septic shock, and so on. The age of patients with noncardiac death was 67.9 ± 12.1 years at the time of the ablation, which was higher than the age of patients with cardiovascular, cardiac, and sudden deaths. Furthermore, the interval between septal ablation and noncardiac death was 6.8 ± 4.3 years. Having in mind that a strict comparison with the cited data is not possible, we do not see any discrepancy with the cited mortality data.
The stepwise procedure was chosen after having found and described a remodeling process in our early-phase experience (2,3). As mentioned in the preceding text and reported earlier, it is known that gradients and systolic anterior motion–related mitral regurgitation decrease over time (2), which supports our strategy to ablate only 1 septal branch per session in patients with subaortic obstruction. This ongoing reduction was also seen in the reported cohort. Furthermore, we also observed significant reductions in nonablated left ventricular posterior wall thickness and maximal septal thickness as an effect of reduction of pressure overload.
Finally, the age of our study population is comparable to most surgical series. As described also by Liebregts et al. (4), younger age is not a contraindication for septal ablation. But it should be underlined that good results in both PTSMA and myectomy in an individual HOCM patient can only be achieved in experienced hypertrophic cardiomyopathy centers taking into account clinical and anatomic findings.
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.
- Liebregts M.,
- Faber L.,
- Jensen M.K.,
- et al.