Trends and Outcomes of Transcatheter Aortic Valve Implantation in Hypertrophic Cardiomyopathy

The landmark clinical trials on the utility of transcatheter aortic valve implantation (TAVI) excluded patients with hypertrophic cardiomyopathy (HCM) and concomitant severe aortic stenosis.1 TAVI in HCM presents unique technical or physiologic challenges called “suicide left ventricle,” that is, sudden reduction in afterload after TAVI exacerbates subvalvular obstruction, which leads to hemodynamic collapse.2 Despite this, TAVI has increasingly been used in patients with HCM with no large-scale data on its safety. There was no significant difference in the proportion of co-morbidities such as heart failure (75.4% vs 78.7%), hypertension (91.0% vs 90.6%), chronic obstructive pulmonary disorder (30.5% vs 29.5%), pulmonary circulatory disorder (25.8% vs 25.4%), obesity (21.6% vs 20.8%), and diabetes mellitus (12.1% vs 11.5%) in the HCM-TAVI and non–HCM-TAVI group, respectively (Figure 1). During the index hospitalization, TAVI in HCM experienced significantly higher adjusted odds of net adverse cardiovascular events (NACE) (7.2% vs 4.4%, aOR 1.70, 95% CI 1.14 to 2.51, p = 0.01), in-hospital mortality (5.1% vs 0.6%, aOR 8.62, 95% CI 3.7 to 20.2, p