Hospital Procedural Volume and Clinical Outcomes Following Septal Reduction Therapy in Obstructive Hypertrophic...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Health Services Research

Background:

• Previous data indicated significant in-hospital mortality for septal myectomy (SM) in obstructive hypertrophic cardiomyopathy (oHCM).
• An inverse relationship between hospital procedure volume and patient outcomes was previously observed for SM.
• Contemporary outcomes and the volume-outcomes relationship for septal reduction therapies in oHCM require updated assessment.

Purpose of the Study:

• To evaluate current in-hospital outcomes for septal reduction therapies in obstructive hypertrophic cardiomyopathy.
• To analyze the relationship between hospital procedural volume and outcomes for both septal myectomy and alcohol septal ablation.
• To identify potential disparities in care based on hospital volume for these oHCM treatments.

Main Methods:

• Analysis of the National Readmission Databases for all septal reduction therapy admissions in the U.S. from 2010 to 2019.
• Stratification of hospitals into low-, medium-, and high-volume tertiles based on annual procedural volume of SM and alcohol septal ablation.
• Comparison of in-hospital mortality, adverse events, and 30-day readmission rates across different hospital volume groups for both procedures.

Main Results:

• Out of 19,007 patients, 12,065 (63%) underwent SM. Overall in-hospital mortality post-SM was 4.0%.
• Low-volume centers (<5 procedures/year) had significantly higher in-hospital mortality (5.7%), adverse events (21.3%), and 30-day readmissions (17.1%) compared to high-volume centers (2.4%, 12.6%, 9.7%, respectively).
• In-hospital mortality and other outcomes for alcohol septal ablation did not differ significantly across hospital volume tertiles.

Conclusions:

• A 4% in-hospital mortality rate for septal myectomy in obstructive hypertrophic cardiomyopathy persists, with a clear inverse volume-outcomes relationship.
• Mortality following alcohol septal ablation was consistent across all hospital volume levels.
• Substantial morbidity associated with septal myectomy was observed across all volume categories, highlighting the need for procedural centralization.