Comparison On Efficacy And Safety For Percutaneous Transluminal Septal Myocardial Ablation In Different Gender Patients Elder Than 60 Of Hypertrophic Obstructive Cardiomyopathy

Objective: To summarize the comparison on efficacy and safety for percutaneous transluminal septal myocardial ablation(PTSMA) in different gender patients elder than 60 of hypertrophic obstructive cardiomyopathy(HOCM)Methods: To screen patients of 44 cases strictly with the inclusion criterion and exclusion criterion for the patients,woman and men elder than 60 of HOCM with typical clinical symptom theated with PTSMA, form 1998-07 to 2013-06 in our hospital. Collected the clinical data and the results of PTSMA, Appling the statistical software of SPSS 13.0 to statisticial analysis, comparing and summarizing the efficacy and occurrence of surgery, after surgery and perioperative period of different groups of patients for PTSMA. all patients were followed up for one year with strict requirements(follow-up events included chest recurring to pain, heart failure getting worse, myocardial infarction, symptom reappearing to do PTSMA, death, etc.).Results: Percutaneous transluminal septal myocardial ablation in the first two groups at baseline comparison: there were 16 cases with coronary artery disease in 44 cases, there were nine cases of coronary artery disease in 30 aged women patients, and there were seven cases with coronary artery disease in the remaining 14 cases of aged men patients, there was no difference between the two groups of patients in the age before the ablation lines, the prevalence of hypertension, coronary artery disease proportions, interventricular septum thickness, left ventricular outflow tract diameter, left ventricular ejection fraction. But the left ventricular outflow tract pressure gradient before surgery of the aged women group resting was significantly higher than older men group [83(50.0 ~ 100.0) vs36.5(30.0 ~ 80.0), P= 0.047]. The patients of HOCM treated by PTSMA, there are 30 cases of aged female patients, of which 29 cases accepted the treatment of PTSMA(including 1 case of a 82-year-old female patient occurred acute cardiac tamponade before injecting absolute ethyl alcohol in surgery, she died of invalid rescue, and did not take percutaneous transluminal septal myocardial ablation), the LVOTPG after resting and after premature significantly declined after surgery than before surgery [12.0(5.0 ~ 21.0) vs 80.0(50.0 ~ 110.0), P = 0.000; 40.0(30.0 ~ 55.0) vs 120.0(100.0 ~ 146.0), P = 0.000]; older male patients in a total of 14 cases all underwent the treatment of PTSMA, the LVOTPG after resting and after premature also significantly declined after surgery than before surgery [7.0(0 ~ 23.0) vs 36.5(30.0 ~ 80.0), P = 0.000; 32.5(20.0 ~ 56.0) vs105.0(90.0 ~ 160.0), P = 0.000]. The resting left ventricular outflow tract pressure gradient of before and after surgery had a slight change value between elderly female and men group [⊿64.0(40.0 ~ 100.0) vs ⊿28.0(15.0 ~ 50.0), P = 0.049], and the left ventricular outflow tract pressure gradient of after premature of the two groups did not change significantly different [⊿88.0(50.0 ~ 110.0) vs ⊿62.5(55.0 ~ 110.0), P = 0.361]. Two overall complication rate of two groups had no significant differenence(P>0.05). Although occurrence rate of serious complications in elderly female patients group(including death, Ⅲ degree atrioventricular block, acute left ventricular failure) was not statistically significant(P>0.05) with older men patients, but had shown a significant increasing trend(26.7% vs 14.3%).Conclusion: The effect of older female and men patients of HOCM to do PTSMA with absolute ethyl alcohol was significantly effective, but older women patients of HOCM might be more likely to occur serious complications when to do PTSMA, so doctors should take more cautious to do PTSMA for older women patients of HOCM than men patients.