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Volume-outcome relationship in septal myectomy for hypertrophic obstructive cardiomyopathy

Joseph Hadaya1, Arjun Verma1, Yas Sanaiha1

  • 1Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California-Las Angeles, CA.

Surgery
|May 25, 2023
PubMed

Insights

Higher septal myectomy volume at hospitals is linked to better outcomes for hypertrophic obstructive cardiomyopathy patients. This includes lower mortality and readmission rates, and more mitral valve repairs.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Health Services Research

Background:

  • Septal myectomy is the primary treatment for severe hypertrophic obstructive cardiomyopathy.
  • Patient outcomes can be influenced by hospital procedure volume.

Purpose of the Study:

  • To investigate the association between hospital septal myectomy volume and cardiac surgery volume with patient outcomes.
  • To determine if higher procedural volume correlates with improved results in septal myectomy patients.

Main Methods:

  • Analysis of adult patients undergoing septal myectomy from the 2016-2019 Nationwide Readmissions Database.
  • Hospitals categorized into low-, medium-, and high-volume based on septal myectomy caseload.
  • Generalized linear models used to assess outcomes including mortality, mitral valve intervention, and readmission.

Main Results:

  • High-volume hospitals showed reduced odds of mortality (0.24) and 90-day readmission (0.59) compared to low-volume hospitals.
  • Patients at high-volume centers were more likely to undergo mitral valve repair versus replacement (OR 5.33).
  • Overall cardiac surgery volume did not correlate with any studied outcomes.

Conclusions:

  • Increased septal myectomy volume is associated with improved patient outcomes, including lower mortality and higher rates of mitral valve repair.
  • These findings support performing septal myectomy at specialized centers with high procedural expertise.
Abstract

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