Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy
Language English Country Great Britain, England Media print
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
29275877
DOI
10.1016/j.cjca.2017.10.020
PII: S0828-282X(17)31109-1
Knihovny.cz E-resources
- MeSH
- Ablation Techniques adverse effects statistics & numerical data MeSH
- Dyspnea etiology MeSH
- Electric Countershock statistics & numerical data MeSH
- Ethanol administration & dosage MeSH
- Cardiomyopathy, Hypertrophic mortality surgery MeSH
- Pacemaker, Artificial statistics & numerical data MeSH
- Cardiovascular Diseases mortality MeSH
- Middle Aged MeSH
- Humans MeSH
- Cardiac Output, Low MeSH
- Retreatment MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Heart Rate MeSH
- Heart Septum surgery MeSH
- Stroke Volume MeSH
- Age Factors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe epidemiology MeSH
- Names of Substances
- Ethanol MeSH
BACKGROUND: The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure. METHODS: We retrospectively evaluated 1310 patients with symptomatic obstructive hypertrophic cardiomyopathy who underwent ASA and were divided into 2 groups. The first-50 group consisted of the first consecutive 50 patients treated at each centre, and the over-50 group consisted of patients treated thereafter (patients 51 and above). RESULTS: In the 30-day follow-up, there was a significant difference in the occurrence of major cardiovascular adverse events (21% in the first-50 group vs 12% in the over-50 group; P < 0.01), which was driven by the occurrence of cardiovascular deaths (2.1% vs 0.4%; P = 0.01) and implanted pacemakers (15% vs 9%; P < 0.01). In the long-term follow-up (5.5 ± 4.1 years), the first-50 group was associated with a significantly higher occurrence of major adverse events (P < 0.01) and higher cardiovascular mortality (P < 0.01). Also, patients in the first-50 group were more likely to self-report dyspnea of New York Heart Association class III/IV (16% vs 10%), to have a left ventricular outflow gradient > 30 mm Hg (16% vs 10%) at the last clinical check-up (P < 0.01 for both), and a probability of repeated septal reduction therapy (P = 0.03). CONCLUSIONS: An institutional experience of > 50 ASA procedures was associated with a lower occurrence of ASA complications, better cardiovascular survival, better hemodynamic and clinical effect, and less need for repeated septal reduction therapy.
Cardiocentre Podlesí Třinec Czech Republic
Department of Cardiology Gentofte Hospital Copenhagen University Hospital Hellerup Denmark
Department of Cardiology Heart and Diabetes Center NRW Ruhr University Bochum Bad Oyenhausen Germany
Department of Cardiology Oslo University Hospital Oslo Norway
Department of Cardiology St Antonius Hospital Nieuwegein Nieuwegein The Netherlands
Department of Interventional Cardiology and Angiology Institute of Cardiology Warsaw Poland
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