In Reply We thank Panaich et al for their letter regarding our article, in which we demonstrated a clear association between institutional procedural volumes and in-hospital outcomes for complex septal reduction procedures, such as septal myectomy and alcohol septal ablation (ASA).1 While we focused on institutional volumes, operator procedural volumes can certainly influence outcomes after complex and rare procedures as well.2,3 The complex interactions between institutional and operator volumes need to be examined further, as low-volume operators can have poor outcomes in large institutions performing high volumes of procedures and vice versa. The results of our study suggest that it is critical to refer patients with hypertrophic cardiomyopathy (HCM) to centers of excellence—with high institutional volumes as well as experienced and skilled high-volume operators—for treatment, particularly when surgical or interventional procedures are required, to ensure procedural success and optimal short- and long-term outcomes.1
Kim LK, Feldman DN. Procedural Volume and Outcomes of Septal Reduction Therapies in Patients With Hypertrophic Obstructive Cardiomyopathy—Reply. JAMA Cardiol. 2017;2(1):111. doi:10.1001/jamacardio.2016.3770
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