Results of Ventricular Septal Myectomy and Hypertrophic Cardiomyopathy (from Nationwide Inpatient Sample [1998e2010]) Sidakpal S. Panaich, MD a , Apurva O. Badheka, MD a, *, Ankit Chothani, MD b , Kathan Mehta, MD c , Nileshkumar J. Patel, MD d , Abhishek Deshmukh, MD e , Vikas Singh, MD f , Ghanshyambhai T. Savani, MD f , Shilpkumar Arora, MD a , Nilay Patel, MD a , Vipulkumar Bhalara, MD a , Peeyush Grover, MD f , Neeraj Shah, MD d , Mahir Elder, MD a , Tamam Mohamad, MD a , Amir Kaki, MD a , Ashok Kondur, MD a , Michael Brown, MD a , Cindy Grines, MD a , and Theodore Schreiber, MD a Ventricular septal myomectomy (VSM) is the primary modality for left ventricular outflow tract gradient reduction in patients with obstructive hypertrophic cardiomyopathy with refractory symptoms. Comprehensive postprocedural data for VSM from a large multi- center registry are sparse. The primary objective of this study was to evaluate post- procedural mortality, complications, length of stay (LOS), and cost of hospitalization after VSM and to further appraise the multivariate predictors of these outcomes. The Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample was queried from 1998 through 2010 using International Classification of Diseases, Ninth Revision, procedure codes 37.33 for VSM and 425.1 for hypertrophic cardiomyopathy. The severity of co-morbidities was defined using the Charlson co-morbidity index. Hierarchical mixed-effects models were generated to identify independent multivariate predictors of in-hospital mortality, proce- dural complications, LOS, and cost of hospitalization. The overall mortality was 5.9%. Almost 9% (8.7%) of patients had postprocedural complete heart block requiring pace- makers. Increasing Charlson co-morbidity index was associated with a higher rate of complications and mortality (odds ratio 2.41, 95% confidence interval 1.17 to 4.98, p [ 0.02). The mean cost of hospitalization was $41,715 – $1,611, while the average LOS was 8.89 – 0.35 days. Occurrence of any postoperative complication was associated with increased cost of hospitalization (D$33,870, p <0.001) and LOS (D6.08 days, p <0.001). In conclusion, the postoperative mortality rate for VSM was 5.9%; cardiac complications were most common, specifically complete heart block. Age and increasing severity of co- morbidities were predictive of poorer outcomes, while a higher burden of postoperative complications was associated with a higher cost of hospitalization and LOS. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;-:-e-) Obstructive hypertrophic cardiomyopathy (HC) is a common genetic disease with variable expressivity, char- acterized by varying degrees of left ventricular outflow tract obstruction. 1 Ventricular septal myectomy (VSM), with >50 years of experience, 2 has been the mainstay for ameliorating outflow tract gradients in patients with medi- cally refractory symptoms. 3,4 Published reports have demonstrated the efficacy of VSM in terms of improvement in hemodynamics and functional status as well as reductions in syncope 5 and sudden cardiac death after surgery. 6e8 Furthermore, VSM offers the added advantage of correct- ing mitral valve apparatus abnormalities associated with HC. 9 However, VSM is a complex procedure with a steep learning curve that is best performed in the hands of expe- rienced operators at advanced tertiary centers with high volumes. 4,10 Most of the available data are limited to experienced surgical centers with skilled high-volume op- erators. 7,11 Real-world data for postprocedural outcomes for VSM from multiple centers across the nation are sparse. Concern regarding postprocedural outcomes has become increasingly germane given an increase in the number of referred patients as well the availability of a less invasive alternative (alcohol septal ablation). 10 The main objectives of our study were (1) to evaluate the postsurgical outcomes of VSM in terms of mortality as well as complications, (2) to further elucidate potential predictors of post-operative outcomes, and (3) to study resource utilization in terms of a Detroit Medical Center, Detroit, Michigan; b MedStar Washington Hospital Center, Washington, District of Columbia; c University of Pitts- burgh Medical Center Shadyside Hospital, Pittsburgh, Pennsylvania; d Staten Island University Hospital, Staten Island, New York; e University of Arkansas, Little Rock, Arkansas; and f University of Miami Miller School of Medicine, Miami, Florida. Manuscript received May 15, 2014; revised manuscript received and accepted July 18, 2014. Drs. Panaich, Badheka, Chothani, and Mehta contributed equally to this report. See page 6 for disclosure information. *Corresponding author: Tel: (408) 324-4516; fax: (203) 737-2437. E-mail address: apurva_badheka@yahoo.com (A.O. Badheka). 0002-9149/14/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. www.ajconline.org http://dx.doi.org/10.1016/j.amjcard.2014.07.075