Abstract 16795: Effect of Operator Volume on Complication of Alcohol Septal Ablation in the United States: A 13 Year Perspective
Background: Alcohol septal ablation (ASA) is one of the key modalities for left ventricular outflow tract (LVOT) gradient reduction in hypertrophic obstructive cardiomyopathy (HOCM)patients with refractory symptoms. Extended follow-up data for ASA from a large multi-center registry is primarily lacking.
Methods: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 1998 and 2010 using the ICD9 procedure code of 37.34 for ablation of heart tissue. Only adult patients with HOCM (ICD-9-CM code 425.1) were included. Out of these, patients with any arrhythmia diagnosis or open surgical ablation procedure code were excluded as well. The NIS represents 20% of all hospitals in the US. We defined severity of co-morbidities using Deyo modification of Charlson co-morbidity index (CCI), where higher scores (0-33) represent increasing burden. Three level hierarchical mixed models were created in order to identify the independent multivariate predictors of complications and mortality for ASA.
Results: A total of 547 (Weighted to US population n=2,685) ASA were available for analysis. The overall mortality was low at 0.4%. Only 0.9% of the patients had significant post-op bleeding necessitating transfusion while 12.3% required a pacemaker. The predictors of combined end point of complications or mortality (OR, 95% CI, p value) were increasing CCI>1 (8.65, 4.39-17.04, p<0.01) and female gender (2.95, 1.44-6.04, p<0.01). Per unit increase in operator volume was associated with a lower rate of complications and mortality (0.85, 0.77-0.94, p<0.01).
Conclusions: ASA carries an overall low mortality rate with cardiac complications being most common. A higher burden of co-morbidities is associated with worse outcomes while a higher yearly operator volume is associated with improved post-procedural outcomes following ASA.
- © 2013 by American Heart Association, Inc.