If this is your first visit, be sure to check out the FAQ in HCMA Announcements. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. Your Participation in this message board is strictly voluntary. Information and comments on the message board do not necessarily reflect the feelings, opinions, or positions of the Hypertrophic Cardiomyopathy Association. At no time should participants to this board substitute information within for individual medical advice. The Hypertrophic Cardiomyopathy Association shall not be liable for any information provided herein. All participants in this board should conduct themselves in a professional and respectful manner. Failure to do so will result in suspension or termination. The moderators of the message board working with the HCMA will be responsible for notifying participants if they have violated the rules of conduct for the board. Moderators or HCMA staff may edit any post to ensure it conforms with the rules of the board or may delete it. This community is welcoming to all those with HCM we ask that you remember each user comes to the board with information and a point of view that may differ from that which you hold, respect is critical, please post respectfully. Thank you

Announcement

Collapse
No announcement yet.

Recent report stating that surgery is superior to ...

Collapse

About the Author

Collapse

HCMA FORUM ARCHIVE Find out more about HCMA FORUM ARCHIVE
This topic is closed.
X
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Recent report stating that surgery is superior to ...

    [Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Erica (---.atlnga1.dsl-verizon.net)

    Date: 10-23-02 18:11

    Check this out ... it was released on 11-Oct-2002

    http://www.medweb.nl/index.htm?/memb...s/06d11nie.htm

    Surgery superior to alcohol ablation for hypertrophic obstructive cardiomyopathy

    NEW YORK (Reuters Health) - For patients with hypertrophic cardiomyopathy and left ventricular outflow obstruction, surgical myotomy-myectomy leads to better exercise test results than does septal alcohol ablation.

    That's the conclusion of a study published in the October 15th issue of the European Heart Journal.

    Transcoronary alcohol septal ablation has been proposed as a less invasive alternative to surgical septal myotomy-myectomy for drug-refractory hypertrophic obstructive cardiomyopathy, in which the anterior mitral valve leaflet contacts the intraventricular septum during systole, the authors explain. However, the comparative aspects of the two procedures on exercise capacity remain uncertain.

    Dr. S. Firoozi and colleagues from St. George's Hospital Medical School in London compared the outcomes of 24 patients who underwent surgical myectomy with those of 20 patients who underwent alcohol septal ablation for the condition.

    Peak left ventricular outflow gradients fell to similar extents after the two treatments, the investigators found, from 83 mm Hg to 15 mm Hg in the myectomy group and from 91 mmHg to 22 mmHg in the alcohol ablation group.

    Also, similar improvements in New York Heart Association (NYHA) functional class and reductions in angina accompanied the gradient reductions with both procedures, the report indicates.

    In contrast, peak oxygen consumption and work rate improved significantly more following myectomy compared with ablation, the researchers note.

    "Although both interventions are acceptable therapies in appropriately selected patients," the authors conclude, "these data suggest that surgery remains the gold standard against which other therapies should be judged."

    "A prospective registry and large-scale prospective studies are required to determine whether the superior effect of surgery on peak oxygen consumption translates into an important clinical benefit for patients and helps clarify the respective roles of these procedures in the management of obstructive hypertrophic cardiomyopathy," the investigators add.

    Eur Heart J 2002;23:1617-1624.

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Sarah B.-Board Moderator (---.client.attbi.com)

    Date: 10-23-02 18:49

    Dear E

    Thanks for posting this. The Summit earlier this month also called myectomys the "gold standard" for HOCMers who are candidates for the surgery.

    Sarah

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Erica Stolzenberg (---.atlnga1.dsl-verizon.net)

    Date: 10-23-02 19:05

    One thing they did not mention was the duration of time - postprocedure - before collecting their data. I would think it would time for healing before true data could be obtained. Just a thought.

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Erica Stolzenberg (---.atlnga1.dsl-verizon.net)

    Date: 10-23-02 19:46

    Thanks Sarah. A few other concerns ... did they use the same exercise protocols? Were the procedures performed at the same institution? Were the gradiants, symptomatic status, ages, severity of obstruction, medications prescibed matched? All these factors would need to be the same if not super close to render true figures.

    Also, this is only the outcome for the exercise test. I wonder what the results were between the two with regards to mortality, gradient reduction, and symptomatic benefits.

    I wish more information was mentioned. I will look into getting my hands on the journal.

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Sarah B.-Board Moderator (---.client.attbi.com)

    Date: 10-23-02 23:17

    Dear Erica,

    All good questions. Medical researchers follow strict protocols. One would have to read the whole, original article to get the study protocols/procedure info. You may try northernlight.com search engine as they often have access to stuff google doesn't.

    S

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Erica Stolzenberg (---.atlnga1.dsl-verizon.net)

    Date: 10-23-02 23:20

    S ... Thanks! ~E

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 10-24-02 08:50

    I really think there needs to be some balance in the ablation vs myectomy debate.

    Frankly i can not figure out why there is so much of a hurry to mandate ablation replaces myectomy. It was very clear at the Summit and has been clear for sometime now that ablation are new, interesting and potentially extremely promising...however it was also clear that many with HOCM needing septal reduction have other issues such as mitral valve abnormalities that make ablation not a suitable treatment option.

    FACT only 25-30% of those with HCM have obstuction - -

    FACT only a percentage of them, maybe 30% will need a septal reduction.

    FACT a percentage of those will have mitral valve involvement or other factors that rule out ablation...FURTHER FACT some may have other medical issues that rule out myectomy.

    FACT we have 40 yrs of experience with long term follow up in myectomy and 6 yrs with ablation. This fact alone makes it risky for a young person to try a procedure with little known about the long term risks.

    FACT EVERYONE is different in ways not always easy to see or understand, even more so when dealing with a doctor or center with limited expereince to the entire disease.

    FACT HCM is not a disease of obstruction it is a disease of cell structure.

    FACT - after septal reduction you still have HCM and still require treatment...sepatal reduction is not a cure, there is no cure.

    **********

    I hope this brings some balance to the subject and I welcome further comments.

    Sincerely,

    Lisa

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Reenie Smith (---.snbrca.adelphia.net)

    Date: 10-24-02 09:56

    Might I also add that to determine which (if any) procedure is right for YOU, the patient, you must first go to a specialist who knows a lot about the procedures to be considered. I believe this would not be something to be determined via phone conversations or any other means besides physically evaluating the patient and the careful evaluation of any and all relevant test results. I have heard people mention that they have decided which procedure is right for them by personal research before they even see the doctor. I think that it's just wrong to get your heart and mind set on something before you know all the facts. I hope I'm not stepping on toes, but you can't be too careful when it comes to tinkering with your ticker.

    Reenie

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Sarah B.-Board Moderator (---.client.attbi.com)

    Date: 10-24-02 12:20

    Dear Reenie,

    you are exactly right.

    Sarah

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: Recent report stating that surgery is superior to alcohol ablation in HCM]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 10-24-02 20:15

    Reenie...

    Heck no..my toes are fine and you are 100% right! In fact you bring up a good point. This happens a great deal in many cases I find people have made up there mind that they want a procedure or a device (most commonly ICD's and ablations) BEFORE ever seeing a doctor who know the disease..and in some cases without a formal diagnosis...

    in one case a woman with Dilated cardiomyopathy yelled at me when I said ablation was not an option... In a different case a man told me he would go any where and pay anything for an ICD...not only did he not have any known risk factors, his septal measurment was around 1.3 so he many not have had HCM it may have been an athletic heart as he had no ECG abnormalities nor symptoms...

    So get the facts 1st ...then think about your treatment!

    Take care

    Lisa
    NOTE: This is a post from the previous forum message board.

Today's Birthdays

Collapse

Working...
X