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Great discussion with @MayraGuerreroMD @SCAI about poor efficacy of alcohol septal ablation for TMVR preparation - results from 30 patient registry
https://www.jacc.org/doi/10.1016/j.jcin.2019.02.034
2 deaths from ablation, only 50% received standalone TMVR, 37% did not augment LVOT above 200mm2.
https://www.jacc.org/doi/10.1016/j.jcin.2019.02.034
2 deaths from ablation, only 50% received standalone TMVR, 37% did not augment LVOT above 200mm2.
But this was the early experience and the results in patients who had septal ablation in the MITRAL trial published this week were good
https://www.jacc.org/doi/10.1016/j.jcin.2021.01.052
So have things got significantly better for pre-emptive alcohol ablation?
https://www.jacc.org/doi/10.1016/j.jcin.2021.01.052
So have things got significantly better for pre-emptive alcohol ablation?
Sadly, not for certain. The MITRAL trial excluded patients at risk of LVOT obstruction. Patients who had septal ablation were enrolled only after it was successful. So we don’t know how many did not do well or did not augment their LVOT after ablation.
Therefore the registry reported by @DeeDeeWangMD and @MayraGuerreroMD remains the best evidence we have to date.
We need better data. Or perhaps a better procedure?
We need better data. Or perhaps a better procedure?
LAMPOON is performed immediately before TMVR, mimics the surgical standard, and learning curve is 3-5 cases to independence. Here are the EFS results.
https://www.jacc.org/doi/10.1016/j.jacc.2019.02.076
https://www.jacc.org/doi/10.1016/j.jacc.2019.02.076
How do these results compare with the MITRAL trial?
For MITRAL
30 day mortality in MAC 16.7% (6.7% in transseptal arm)
30 day mortality in Ring 7%
For LAMPOON
30 day mortality in MAC 13%
30 day mortality in Ring 0%
For MITRAL
30 day mortality in MAC 16.7% (6.7% in transseptal arm)
30 day mortality in Ring 7%
For LAMPOON
30 day mortality in MAC 13%
30 day mortality in Ring 0%
But this is a treacherous comparison:
The numbers are tiny
They are subgroups within different trials
Most importantly, all LAMPOON patients enrolled at risk of LVOT obstruction - totally different from the MITRAL trial (in fact, LAMPOON enrolled MITRAL screen failures)
The numbers are tiny
They are subgroups within different trials
Most importantly, all LAMPOON patients enrolled at risk of LVOT obstruction - totally different from the MITRAL trial (in fact, LAMPOON enrolled MITRAL screen failures)
In summary, while great for HOCM, perhaps alcohol should come with a warning before TMVR. Catch the discussion @SCAI
@AdamGreenbaumMD @J_M_McCabe @JasonFoerst @GilbertTangMD @EleidMack @bapat_savrtavr @PaulMahoneyMD @modine_thomas @KendraGrubb @SrihariNaiduMD @adnanalkhouli
@AdamGreenbaumMD @J_M_McCabe @JasonFoerst @GilbertTangMD @EleidMack @bapat_savrtavr @PaulMahoneyMD @modine_thomas @KendraGrubb @SrihariNaiduMD @adnanalkhouli
