Benefits of surgery in obstructive hypertrophic cardiomyopathy: bring septal myectomy back for European patients

Introduction: Septal reduction therapy (SRT) - i.e., septal myectomy and alcohol septal ablation - has been used to treat medically-refractory obstructive hypertrophic cardiomyopathy (HOCM) for a few decades. However, the effects of SRT on the risk of acute cardiovascular (CV) events and all-cause mortality are largely unknown. Hypothesis: SRT is associated with a long-term decrease in acute CV events and a short-term increase in all-cause mortality in patients with HOCM. Methods: We performed a propensity score (PS)-matched study using all-payer databases that capture all hospitalizations and outpatient visits in New York State. We identified patients with HOCM who underwent SRT between January 1, 2007 and December 31, 2014 (i.e., the SRT group) and those who have never had SRT but had at least one hospitalization for HOCM during the same period (i.e., the control group). We performed 1:1 PS matching using age, sex, race/ethnicity, source of payment, season and year of starting event follow-up (i.e., the day of SRT or the index hospitalization), and Elixhauser comorbidity measures. The primary outcomes were (1) acute CV event (i.e., emergency department visit or unplanned hospitalization for CV disease) during 1-360 days and 361-720 days and (2) 7-, 15-, 30-, 180-, and 360-day all-cause mortality. We compared the risk of the outcome event using logistic regression models. Results: The analytic cohort consisted of 690 patients with HOCM (i.e., 345 PS-matched pairs). The SRT group had a lower risk of acute CV event during 361-720 days (OR 0.44; 95% CI, 0.20-0.97; P=0.04) but a higher risk of 7-day mortality (11 vs. 2 in the control group; P=0.03). The SRT group had a non-significant trend towards lower all-cause mortality in longer terms ( Figure ). Conclusion: In this population-based PS-matched study of patients with HOCM, SRT was associated with a reduced risk of acute CV events in the second post-procedure year at the sacrifice of a short-term increase in all-cause mortality.

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Short-term outcomes of surgical atrial ablation and septal myectomy

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-51-60 ◽

2021 ◽

Vol 25 (3) ◽

pp. 51

Author(s):

A. S. Zalesov ◽

A. V. Bogachev-Prokophiev ◽

A. V. Afanasyev ◽

R. M. Sharifulin ◽

A. V. Sapegin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Sinus Node ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Radiofrequency Energy ◽

Short Term ◽

Surgical Ablation ◽

Septal Myectomy ◽

Atrial Ablation ◽

Obstructive Hypertrophic Cardiomyopathy

Background. Hypertrophic cardiomyopathy is one of the most common types of cardiomyopathy. The appearance of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is associated with significant clinical worsening. Outcomes of surgical ablation and septal myectomy in these patients are limited. Aim. This retrospective study aimed to evaluate short-term outcomes of concomitant surgical ablation and septal myectomy in patients with obstructive hypertrophic cardiomyopathy and atrial fibrillation. Methods. Fifty-five patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent concomitant surgical ablation and septal myectomy between 2014 and 2019 were analysed. Patients with paroxysmal atrial fibrillation predominantly underwent left atrial ablation, and those with nonparoxysmal atrial fibrillation predominantly underwent the Maze IV procedure. Surgical ablation was performed using cryoablation alone (83.6%) or in combination with radiofrequency energy (16.4%). Results. Hospital mortality was 1.8%. Incidence of major adverse events was 3.6%. Sinus node dysfunction and atrioventricular block occurred in 7.3% and 1.8% of patients, respectively. Bleeding requiring revision occurred in 2 (3.6%) patients. Forty-nine (89.1%) patients had stable sinus rhythm and five (9.1%) were on dual-chamber pacemaker stimulation at the time of discharge. Conclusion. Concomitant septal myectomy and surgical ablation are feasible and safe in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.Received 5 April 2021. Revised 16 May 2021. Accepted 17 May 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors Conception and study design: A.S. Zalesov, A.V. Bogachev-Prokophiev Data collection and analysis: A.S. Zalesov, S.A. Budagaev, A.V. Sapegin Statistical analysis: A.S. Zalesov, A.V. Afanasyev, R.M. Sharifulin Drafting the article: A.S. Zalesov Critical revision of the article: A.V. Bogachev-Prokophiev, S.I. Zheleznev, I.I. Demin Final approval of the version to be published: A.S. Zalesov, A.V. Bogachev-Prokophiev, A.V. Afanasyev, R.M. Sharifulin, A.V. Sapegin, S.A. Budagaev, S.I. Zheleznev, I.I. Demin

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Abstract 13590: Demographic and Clinical Characteristics of Patients With Obstructive Hypertrophic Cardiomyopathy in a Large, Nationwide Us Cohort

Circulation ◽

10.1161/circ.142.suppl_3.13590 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael Butzner ◽

Phil Sarocco ◽

Ethan J Rowin ◽

Martin S Maron ◽

Laura A Robertson

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Characteristics ◽

National Sample ◽

Centers Of Excellence ◽

Septal Myectomy ◽

Level Data ◽

Obstructive Hypertrophic Cardiomyopathy ◽

Integrated Delivery ◽

Comorbidity Index ◽

Delivery Networks

Background: Obstructive hypertrophic cardiomyopathy (oHCM) has mostly been studied in patients treated in advanced comprehensive Centers of Excellence (COE). Understanding the true prevalence of patients with oHCM in the general US population may improve the screening, identification, and treatment outside of COEs. Objectives: To describe the demographics and clinical characteristics of patients with oHCM. Methods: This is a retrospective cohort study to assess patient-level data from the IBM Explorys database (observational period: January 1, 2010 to December 31, 2018). The Explorys database amassed electronic medical records from 39 Integrated Delivery Networks (IDN) from ~12,982,704 patients. We identified adult patients (>18 years old) with oHCM and report their demographics and clinical characteristics from index date to the end of study period. Results: Of 8,792 patients, 53.0% were female, and 81.2% Caucasian (mean index age: 61.8 years). Primary insurance type was private (58.9%); 54.9% of patients lived in the Midwest. Mean BMI at index was 30.4; 30.9% were nondrinkers. The mean Quan-Charlson Comorbidity Index was 6.35% with the most common comorbidities being congestive heart failure (31.9%), chronic pulmonary disease (20.1%), and diabetes without chronic complications (16.9%). CV drug rates included β-blockers (80.5%), CCBs (46.0%), ACE inhibitors (27.7%), ARBs (18.8%), disopyramide (2.4%) and amiodarone (13.0%). Surgical procedure rates included septal myectomy (22%), ablation (19.8%), implantable cardioverter defibrillator (11.2%), and heart transplantation (0.3%). Major residual side effects subsequent to surgical procedures included atrial fibrillation (31.4%) and reintervention (15.6%). Common reintervention procedures included ablation and septal myectomy. Conclusions: This is the first study to examine a national sample of oHCM patients using clinical data from more than 39 IDNs. Leveraging the Explorys database allowed us to analyze a larger, more diverse cohort of oHCM patients across the entire broader US. The results from this analysis may be used to compare the characteristics of patients with oHCM in the general population with those treated in COE.

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