Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery

Ashwat Dhillon, Ashish Khanna, Mandeep Singh Randhawa, Jacek Cywinski, Leif Saager, Maran Thamilarasan, Harry M. Lever, Milind Y. Desai

Research output: Contribution to journalArticle

Abstract

Objective Due to their unique pathophysiological profile, patients with hypertrophic cardiomyopathy (HCM) undergoing non-cardiac surgery require additional attention to perioperative management. We sought to compare perioperative outcomes of patients with HCM undergoing non-cardiac surgery with a matched group patients without HCM. Methods This observational cohort study conducted at a tertiary care centre included patients with HCM (n=92, age 67 years, 54% men) undergoing intermediate-risk and high-risk non-cardiac surgeries between 1/2007 and 12/2013 (excluding >18 years, prior septal myectomy/ alcohol ablation, low-risk surgery) who were 1:2 matched (based on age, gender, type and time of noncardiac surgery) with patients without HCM (n=184, median age 65 years, 53% men). A composite endpoint (30-day postoperative death, myocardial infarction, stroke, in-hospital decompensated congestive heart failure (CHF) and rehospitalisation within 30 days) and postoperative atrial fibrillation (AF) were recorded. Results There was a significantly lower incidence of intraoperative hypotension/tachycardia in patients with HCM versus those without HCM (p>0.001). At 30 days postoperatively, 42 (15%) patients had composite events. Rates of 30-day death, MI or stroke were very low in patients with HCM (5%). However, a significantly higher proportion of patients with HCM met the composite endpoint versus patients without HCM (20 (22%) vs 22 (12%), p=0.03), driven by decompensated CHF. On logistic regression, HCM, high-risk non-cardiac surgery, high anaesthesia risk score and intraoperative duration of hypotension were independently associated with 30-day composite events ( p>0.05). Conclusions Patients with HCM undergoing high-risk and intermediate-risk non-cardiac surgeries have a low perioperative event rate, at an experienced centre. However, they have a higher risk of composite events versus matched patients without HCM.

Original languageEnglish (US)
JournalHeart
DOIs
StateAccepted/In press - Jun 10 2016
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery'. Together they form a unique fingerprint.

  • Cite this

    Dhillon, A., Khanna, A., Randhawa, M. S., Cywinski, J., Saager, L., Thamilarasan, M., Lever, H. M., & Desai, M. Y. (Accepted/In press). Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery. Heart. https://doi.org/10.1136/heartjnl-2016-309442