Heart failure & cardiomyopathiesCohort study
Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction
- Retrospective cohort study
- single-centre
- compassionate use
Authors' conclusion
With further experience, SESAME may benefit patients requiring septal reduction therapy for obstructive hypertrophic cardiomyopathy as well as those with LVOT obstruction after heart valve replacement, and/or can help facilitate transcatheter valve implantation.
Study context
- Population
- Patients with symptomatic left ventricular outflow tract (LVOT) obstruction or needing space to facilitate transcatheter mitral valve replacement (TMVR) or transcatheter aortic valve replacement (TAVR), 2021–202311 (14%) classic hypertrophic cardiomyopathy (HCM)
- Participants
- 76 patients
- Exposure
- Before vs after septal scoring along midline endocardium (SESAME)
- SESAMEn = 76
Main finding
As reported in the abstract
Technical success and predicted post-TMVR LVOT area
- Technically successful SESAME myocardial laceration in all
- After SESAME vs Before SESAME: P < 0.001
- After SESAME vs Before SESAME: P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Invasive LVOT gradient (HCM subgroup) — After SESAME vs Before SESAME · resting 54 [Q1-Q3: 40-70] to 29 [Q1-Q3: 12-36] | P = 0.023 |
| Invasive LVOT gradient (HCM subgroup) — After SESAME vs Before SESAME · provoked 146 [Q1-Q3: 100-180] to 85 [Q1-Q3: 40-120] | P = 0.076 |
| Remaining septum thickness (laceration stability) | P = 0.8 |
- Remaining septum thickness (laceration stability): 5.9 ± 3.3 to 6.1 ± 3.2; lacerations stable, did not propagate
Procedural survival and complications
- Survived the procedure
- 74 (97.4%)
- Iatrogenic ventricular septal defects (no repair required)
- 3 of 76 (3.9%)
- Ventricular free wall perforations
- 3 of 76 (3.9%)
- Permanent pacemaker
- 4 of 76 (5.3%)
- Neither VSD nor perforation occurred in HCM patients
- 2 pacemakers after concomitant TAVR
Original publication
Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction. J Am Coll Cardiol. Published 11 March 2024. doi:10.1016/j.jacc.2024.02.007
Summarised from the published abstract; every number is checked against it