![]() Other changes in technique, such as using small, flexible, screw-in temporary pacemaker wires to avoid myocardial perforation, all come with experience. The selection of smaller branches of septal perforator arteries that directly target the region of systolic anterior motion with septal contact using echographic contrast injections allows for smaller volumes of alcohol while maintaining the optimal hemodynamic results. The mean of 3.7 mL of alcohol used in the study herein discussed is larger than the 1.5 to 2.0 mL used by more experienced centers and may account for the need for transplant and implantable cardioverter-defibrillators (ICD) in the patient cohort. There is a balance between a higher volume of alcohol used in the procedure producing better hemodynamic results and the possible long-term detrimental consequences of adverse myocardial remodeling and ventricular arrhythmias. 2 Thus, it would be expected that the long-term results of ASA in Spain will become even better as centers gain greater experience. ![]() We and others have shown that the success and complications rate of ASA significantly improve after a procedural volume of > 50 patients. The authors clearly state in their discussion that the results of either septal myectomy or ASA depend on operator experience, as well as an understanding of the disease itself. In addition, it would have been interesting to know whether the surgical myectomy population differed from those undergoing ASA or whether the decision was made on the basis of institutional expertise and facilities. It would have been of interest to know whether the use of septal reduction therapy increased over time. The numbers of patients in this reported experience from 5 centers is small, as are the numbers undergoing surgical myectomy. 1 Although the series reflects an earlier experience with a technique that continues to evolve over time, the encouraging long-term outcomes bode well for the next generation of patients who will undergo ASA after what we would hope is an adequate trial of medical therapy. In the Maxillofacial Institute we have been working for years with piezoelectric energy, making the surgical procedures performed in our center minimally invasive, more accurate, and much safer.The article published in Revista Española de Cardiología describing the 10-year follow-up after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) is a welcome addition to the literature. ![]() Thus, piezoelectric devices ensure the total preservation of soft tissues, including the microvessels of the alveolar nerves, avoiding stretching and heating the nerve, making it an ideal instrument to be used in the borderline between soft tissues and the bone, thus reducing the risk of traumatizing neighboring soft tissues.Īs a consequence, after a surgery performed with a piezoelectric scalpel there is less trauma for the patient, and the recovery and healing of wounds is faster. The piezoelectric or ultrasonic scalpel is an electro-medical device for bone surgery (or osteotomy) that involves the use of ultrasonic microwaves of 60 to 200 μm / s at 24 to 29 kHz to cut mineralized tissue, allowing the soft tissue to remain unharmed. In the maxillofacial territory, bone, nerves and neighboring vessels are closely interconnected, making it an especially complicated area when performing surgery.
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