Josef Veselka1, Lothar Faber2, Morten Kvistholm Jensen3, Robert Cooper4, Jaroslav Januska5, Jan Krejci6, Thomas Bartel7, Maciej Dabrowski8, Peter Riis Hansen9, Vibeke Marie Almaas10, Hubert Seggewiss11, Dieter Horstkotte2, Radka Adlova12, Henning Bundgaard3, Jurriën Ten Berg13, Max Liebregts13. 1. Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic. Electronic address: veselka.josef@seznam.cz. 2. Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany. 3. Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 4. Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, England. 5. Cardiocentre Podlesí, Třinec, Czech Republic. 6. 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Center, St Anne's University Hospital and Masaryk University, Brno, Czech Republic. 7. Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria; Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 8. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 9. Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark. 10. Department of Cardiology, Oslo University Hospital, Oslo, Norway. 11. Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany; Department of Internal Medicine, Hospital Schweinfurt, Schweinfurt, Germany. 12. Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic. 13. Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Abstract
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.
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.
Authors: Angelos G Rigopoulos; Muhammad Ali; Elena Abate; Marios Matiakis; Hannes Melnyk; Sophie Mavrogeni; Dionyssios Leftheriotis; Boris Bigalke; Michel Noutsias Journal: Heart Fail Rev Date: 2019-05 Impact factor: 4.214
Authors: Jiří Bonaventura; Patricia Norambuena; Pavel Votýpka; Hana Hnátová; Radka Adlová; Milan Macek; Josef Veselka Journal: Cardiovasc Diagn Ther Date: 2020-04