Results of Ventricular Septal Myectomy and Hypertrophic Cardiomyopathy (from Nationwide Inpatient Sample [1998–2010])

Panaich, Sidakpal; Badheka, Apurva; Chothani, Ankit; Mehta, Kathan; Patel, Nileshkumar; Deshmukh, Abhishek; Singh, Vikas; Savani, Ghanshyambhai T.; Arora, Shilpkumar; Patel, Nilay; Bhalara, Vipulkumar; Grover, Peeyush; Shah, Neeraj; Elder, Mahir; Mohamad, Tamam; Kaki, Amir; Kondur, Ashok; Brown, Michael A.; Grines, Cindy L.; Schreiber, Theodore

doi:10.1016/j.amjcard.2014.07.075

Cited by 107 publications

(68 citation statements)

References 23 publications

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“…However, the NIS represents a large sample size for a comprehensive outcome analysis and a sound sampling design that has been widely used for research previously. 10,30 A higher hospital volume is associated with superior postprocedural complication rate and inhospital mortality after peripheral endovascular interventions. This coupled with lower hospitalization costs in higher volume hospitals indicate a need for further research in this field and possible revision of competency guidelines to include a minimum required hospital procedural volume.…”

Section: Discussionmentioning

confidence: 99%

Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])

Arora

Panaich

Patel

et al. 2015

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])

Arora

Panaich

Patel

et al. 2015

The American Journal of Cardiology

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“…As there is a direct relation between volume of myectomies performed and surgical outcomes, optimal results cannot be expected from surgeons with a low-volume exposure to symptomatic patients with obstructive HCM (1,15,16). Therefore, the best results have been obtained by those few surgeons in the world with extensive myectomy experience and a small number of referral centers in North America and Europe (5,7,11,(17)(18)(19)(20).…”

Section: Surgical Septal Myectomymentioning

confidence: 99%

Alcohol septal ablation: in which patients and why?

Spirito¹,

Rossi²,

Maron³

2017

Ann. Cardiothorac. Surg.

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At present, surgical septal myectomy is regarded as the "gold standard" treatment for most patients with obstructive hypertrophic cardiomyopathy (HCM) and drug-refractory symptoms. However, the best results are obtained by those surgeons who have extensive experience with this operation at a small number of referral centers. In the mid-1990s, percutaneous alcohol septal ablation was introduced as an alternative to myectomy to reduce LV outflow gradient and heart failure symptoms in patients with obstructive HCM. However, certain features of alcohol ablation limit its applicability to carefully selected patients.Because this procedure involves the injection of 1-4 mL of 96% ethanol into a septal perforator of the left anterior coronary artery to produce a myocardial infarction (with septal thinning, outflow tract widening and gradient reduction), alcohol ablation is limited by the size and distribution of the septal perforator branches. In addition, rich blood supply from other septal branches not occluded by the balloon and from the posterior descending coronary artery may restrict myocardial ischemia to portions of the septum that do not contribute to outflow obstruction. Septal hypertrophy may be either mild or particularly marked, and abnormalities of mitral valve apparatus may also play a major role in outflow obstruction. When such features are present, alcohol-induced septal thinning is unlikely to significantly reduce the gradient. In addition, persisting uncertainties regarding the risk for ventricular tachyarrhythmias after alcohol ablation suggest this procedure should be limited to patients of advanced age, patients at unacceptable operative risk due to comorbidities, or those with strong aversion to surgery. Further progress in the treatment for patients with obstructive HCM and severe refractory symptoms will come from assuring proper patient selection for alcohol septal ablation, as well as increasing the number of surgeons and centers experienced in performing septal myectomy. PerspectiveIn patients with hypertrophic cardiomyopathy (HCM), left ventricular (LV) outflow obstruction with a pressure gradient between the LV outflow tract and aorta is caused by systolic anterior motion of the mitral valve against the septum (1), and is identified at rest or with physiologic exercise in about 70% of patients evaluated at tertiary referral centers (2). Obstruction to LV outflow obstruction is associated with mitral valve regurgitation, disabling heart failure symptoms and increased cardiovascular mortality (3,4). For almost 50 years, transaortic septal myectomy has represented the standard surgical approach for the treatment of patients with obstructive HCM and severe symptoms refractory to medical treatment (1,5-7).In the mid-1990s, percutaneous alcohol septal ablation was introduced as an alternative to surgical myectomy to reduce the LV outflow gradient and heart failure symptoms in patients with obstructive HCM (8). This catheterbased procedure, made attractive by its less invasive nature, was rapidl...

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“…Given the paucity of data at experienced centres, we decided to investigate outcomes after non-cardiac surgery in patients with HCM at our institute, which is well experienced in managing the full spectrum of patients with HCM, especially taking into account the higher incidence of hard events from a previous sample 10. The results of the current study underscore the importance of experience in managing patients with HCM,23 25 26 not just HCM-based symptoms, but even when they need non-cardiac surgery. While the current results demonstrate a higher rate of composite primary events in patients with HCM, even at our tertiary care centre, it is important to note that the hard events such as death, MI and stroke were very low and not significantly different from patients without HCM.…”

Section: Discussionmentioning

confidence: 87%

Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery

Dhillon¹,

Khanna

Randhawa³

et al. 2016

Heart

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Results of Ventricular Septal Myectomy and Hypertrophic Cardiomyopathy (from Nationwide Inpatient Sample [1998–2010])

Cited by 107 publications

References 23 publications

Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])

Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])

Alcohol septal ablation: in which patients and why?

Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery

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