Abstract 11351: Surgical Myectomy versus Alcohol Septal Ablation Among Patients With HOCM: A Systematic Review and Meta-Analysis

Background: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are two known therapies recommended for symptomatic hypertrophic cardiomyopathy patients. Although, their results are contradictory between the outcomes of these two procedures to this day. Hypothesis: This meta-analysis evaluates and compares the two procedure-related clinical outcomes. Method: We performed a systematic literature search on PubMed, Embase and Cochrane for relevant articles from inception until May 20, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Result: A total of 23 articles with 17165 patients comparing the outcomes among SM vs ASA with a mean follow-up of 44.18±24.06 months. The odds of short-term mortality [OR, 0.51(95%CI: 0.33-0.79), p = 0.002] were significantly lower in ASA group, while reintervention [OR, 2.93 (95%CI: 0.99-8.70), p = 0.05], and pacemaker implantation [OR, 1.97(95%CI: 1.28-3.03), p = 0.002] were significantly higher among ASA group compared to SM. Long term mortality [OR, 0.91(95%CI: 0.57-1.47), p = 0.71], SCD [OR, 1.55(95%CI: 0.76-3.17), p = 0.23], CVM [ OR, 0.76(95%CI: 0.39-1.46), p = 0.40], Stroke [OR, 1.24(95%CI: 0.24-6.26), p = 0.80], and MI [OR, 1.04(95%CI: 0.19-5.57), p = 0.97] were not different between both procedures. Conclusion: ASA and SM procedure for treating HOCM carries a similar risk of long-term mortality and other cardiovascular and cerebrovascular outcomes among both groups. However, ASA carries a lower incidence of short-term mortality and higher incidence of reintervention and pacemaker implantation than SM.