Is Surgery Best for HOCM?

Percutaneous transluminal septal myocardial ablation (PTSMA) with injected ethanol is being used increasingly to reduce the left-ventricular outflow tract (LVOT) gradient nonsurgically in patients with hypertrophic obstructive cardiomyopathy (HOCM). In a nonrandomized study from the Netherlands, 72 patients with symptomatic HOCM despite optimal medical treatment underwent PTSMA (43 patients) or myectomy plus anterior mitral leaflet extension with a pericardial patch (29 patients). All subjects had a mitral leaflet area of >12 cm² (mean, 16 cm²).

The groups had similar baseline demographic and echocardiographic characteristics (mean septal thickness, 22 mm; mean LVOT, 101 mm Hg). However, compared with the PTSMA group, the surgery group was y…