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Background <p>Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary cardiac disease associated with poor prognosis. Data on septal reduction therapy (SRT), including transcoronary ablation of septal hypertrophy (TASH) and surgical myectomy (SM), are limited. We aimed to evaluate temporal trends, patient characteristics, in-hospital outcomes, and the influence of institutional procedural volumes in a nationwide cohort.</p> Methods <p>We used nationwide administrative data from the German Federal Bureau of Statistics to identify HOCM patients undergoing TASH or SM between 2006 and 2019. Primary outcomes were in-hospital mortality and pacemaker implantation. Multivariable logistic regression assessed associations with institutional procedure volume.</p> Results <p>Among 8,514 SRT procedures, 5,293 (62.2%) were TASH and 3,221 (37.8%) SM. Annual volumes increased for both procedures between 2006 and 2019. SM patients were older (67.4 vs. 60.2&#xa0;years), more often male, and had a higher comorbidity burden. Of all centers, 49.3% performed ≤ 20 SM per year, and 76.3% performed ≤ 20 TASH per year. Mitral surgery occurred in 36.1% of SM cases. In-hospital mortality was higher for SM than TASH (6.9% vs. 0.8%), while pacemaker implantation was more frequent with TASH (19.3% vs. 13.1%). Risk of in-hospital mortality after SM was higher in low-volume centers than in large centers (adjusted odds ratio 2.64; 95% confidence interval, 1.49–4.66).</p> Conclusion <p>SM was performed in older, more comorbid patiens and frequently included concomitant valve surgery. Higher in-hospital mortality at low-volume centers may partially reflect surgical complexity or case mix rather than volume alone. Our findings underscore the need for individualized referral strategies to experienced centers.</p> Graphical Abstract <p></p>

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Temporal trends, patient characteristics and hospital volume outcomes after transcoronary ablation of septal hypertrophy and septal myectomy for treatment of obstructive hypertrophic cardiomyopathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月9日

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  • Peter Moritz Becher,
  • Fabian J. Brunner,
  • Jessica Weimann,
  • Marko Remmel,
  • Benedikt Schrage,
  • Monica Patten,
  • Christian Detter,
  • Hermann Reichenspurner,
  • Paulus Kirchhof,
  • Stefan Blankenberg,
  • Moritz Seiffert

摘要

Background

Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary cardiac disease associated with poor prognosis. Data on septal reduction therapy (SRT), including transcoronary ablation of septal hypertrophy (TASH) and surgical myectomy (SM), are limited. We aimed to evaluate temporal trends, patient characteristics, in-hospital outcomes, and the influence of institutional procedural volumes in a nationwide cohort.

Methods

We used nationwide administrative data from the German Federal Bureau of Statistics to identify HOCM patients undergoing TASH or SM between 2006 and 2019. Primary outcomes were in-hospital mortality and pacemaker implantation. Multivariable logistic regression assessed associations with institutional procedure volume.

Results

Among 8,514 SRT procedures, 5,293 (62.2%) were TASH and 3,221 (37.8%) SM. Annual volumes increased for both procedures between 2006 and 2019. SM patients were older (67.4 vs. 60.2 years), more often male, and had a higher comorbidity burden. Of all centers, 49.3% performed ≤ 20 SM per year, and 76.3% performed ≤ 20 TASH per year. Mitral surgery occurred in 36.1% of SM cases. In-hospital mortality was higher for SM than TASH (6.9% vs. 0.8%), while pacemaker implantation was more frequent with TASH (19.3% vs. 13.1%). Risk of in-hospital mortality after SM was higher in low-volume centers than in large centers (adjusted odds ratio 2.64; 95% confidence interval, 1.49–4.66).

Conclusion

SM was performed in older, more comorbid patiens and frequently included concomitant valve surgery. Higher in-hospital mortality at low-volume centers may partially reflect surgical complexity or case mix rather than volume alone. Our findings underscore the need for individualized referral strategies to experienced centers.

Graphical Abstract