SPC365

One-year outcomes of alcoholic septal ablation in a tertiary reference center

Session: SESSÃO DE POSTERS 40 - INTERVENÇÃO CORONÁRIA
Speaker: Miguel Marques Antunes

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Cartazes
FP Number: ---
Authors: Miguel Marques Antunes; Julien Lopes; André Grazina; Pedro Garcia Brás; Sílvia Aguiar Rosa; Ana Galrrinho; Duarte Cacela; Rui Cruz Ferreira; António Fiarresga

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Background:&nbsp;</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Alcoholic septal ablation (ASA) is a minimally invasive procedure employed to alleviate left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM). We present the 1-year follow up of consecutive patients undergoing this procedure at our hospital.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Methods:</span></span></strong><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"> </span></span></strong></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">We enrolled consecutive patients with a diagnosis of HOCM that underwent ASA at our hospital</span></span><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">. </span></span></strong><span style="font-size:11.0pt">Patient baseline characteristics, intraprocedural data </span><span style="font-size:11.0pt">(e.g., maximal wall thickness, alcohol dosage</span><span style="font-size:11.0pt">, new-onset bundle branch blocks) and transthoracic echocardiogram (TTE) data were recorded. The primary outcome of procedural success was based on an echocardiographic improvement of left ventricular outflow tract (LVOT) gradient reduction of over 50% at </span><span style="font-size:11.0pt">3, 6, or 12 months). Safety endpoints of intraprocedural mortality and 12-month cardiovascular and all-cause mortality were also assessed. A paired t-test was used to ascertain the significance of the primary outcome.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Results:</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">A total of 170 consecutive patients with an average age of 68&plusmn;11 years, 104 (61%) of which female were enrolled in this analysis. Patients had significant symptoms (Median NYHA Class 3 [3-3]; Angina &ndash; 47% of patients), despite high rates of beta-blocker and calcium channel blocker use (90% and 39% of patients, respectively) (Table 1). &nbsp;Procedurally, an average of 2 cc [IQR 1.8&ndash;2.2] of alcohol was administered, with a new right bundle branch block (RBBB) in 46% and pacemaker implantation in 18% of patients. Significant LVOT gradient reduction was achieved - 84% [IQR 60&ndash;94] at 12 months)- &nbsp;with &gt;50% reduction seen in 87% and 79% of patients at 3&ndash;12 and 6&ndash;12 months post-ASA, respectively (Figure 1.). A paired t-test comparing LVOT gradient at baseline and 12-months demonstrated a mean gradient decrease from 94.1 mmHg (baseline) to 22.1 mmHg (12 months), with a mean difference of 72.0 mmHg (95% CI: 59.3&ndash;84.6, p &lt; 0.0001), confirming the effectiveness of ASA in reducing LVOT obstruction. Intraprocedural mortality occurred in one patient (mortality rate 0.01%), due to acute mitral regurgitation. Six patients died at a 12-month follow-up, half of which from cardiovascular causes &ndash; one previously mentioned, one from massive pulmonary thromboembolism, and one from cardiogenic shock.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Conclusion:</span></span></strong><br />
<span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">ASA is safe and&nbsp;effectively reduces LVOT gradient, alleviating&nbsp; symptoms in HOCM patients, with sustained improvements up to 12 months post-procedure.</span></span></span></span></p>