New study highlights impact of experience on outcomes in hypertrophic cardiomyopathy septal reduction procedures

UAB researchers explore how polygenic risk scores can refine antihypertensive treatment decisions.Researchers from the University of Alabama at Birmingham Marnix E. Heersink School of Medicine have published a study in the Journal of the American Heart Association that focuses on how the volume of procedures influences patient outcomes undergoing septal reduction therapies for hypertrophic obstructive cardiomyopathy.

Hypertrophic cardiomyopathy is an inherited condition that affects up to 750,000 people in the United States. It often involves left ventricular outflow tract obstruction. Septal reduction therapies are key interventions for patients whose symptoms persist despite medical treatment. This study highlights how high-volume centers, where operators perform these procedures more frequently, achieve better outcomes, including lower 30-day mortality and reduced complication rates.

The research, led by Nirav Patel, M.D., and colleagues, analyzed over 5,700 patients across more than 150 academic medical centers in the United State from 2016-2022. More than 90 percent of these procedures were performed by surgeons and interventionists at hospitals that carried out fewer than 10 procedures annually. This lack of experience translated into worse outcomes for patients. For instance, those who underwent septal myectomy at low-volume centers or by low-volume operators faced nearly double the risk of 30-day in-hospital mortality and significantly higher odds of complications and 90-day readmissions compared to those treated at high-volume centers.

"Our study underscores the importance of referring patients to experienced, high-volume centers for these specialized procedures," Patel said. "By doing so, we can help reduce the risk of complications and improve survival rates for patients with HCM."

The implications for alcohol septal ablation were even more pronounced. Patients treated by low-volume operators had a three- to fourfold increase in the risk of 30-day mortality and higher rates of complications such as bleeding and acute kidney failure. Notably, hospital volume did not seem to influence outcomes for alcohol septal ablation as strongly as it did for septal myectomy; but operator experience remained critical.

"For patients with obstructive HCM, septal reduction therapy can be life-changing; but the risks are significantly higher in less experienced hands," said Pankaj Arora, M.D., a senior author on the study and a leading physician-scientist at the UAB Cardiovascular Institute. "This is why we always advocate for patients to seek care at centers of excellence, where the operators perform these procedures routinely."

"Patients should be aware that choosing the right center and the right operator can make a significant difference in their outcomes," said Mustafa Ahmed, M.D., director of Interventional Cardiology and Structural Heart Disease at the UAB Cardiovascular Institute. "High-volume centers with the appropriate expertise, volume and experience can greatly improve recovery and long-term survival."

The study calls for important quality standards to be considered when selecting centers and surgeons for septal myectomy and alcohol septal ablation. These standards include operator experience, patient outcomes and the ability to provide comprehensive post-procedure care.

"This study, utilizing data from the Vizient Clinical Data Base, represents a significant advancement in understanding how clinical outcomes for HCM patients are shaped by procedural volume and reinforces the value of high-volume, specialized care for improving patient survival," Arora said.