TY - JOUR
T1 - Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery
AU - Dhillon, Ashwat
AU - Khanna, Ashish
AU - Randhawa, Mandeep Singh
AU - Cywinski, Jacek
AU - Saager, Leif
AU - Thamilarasan, Maran
AU - Lever, Harry M.
AU - Desai, Milind Y.
PY - 2016/6/10
Y1 - 2016/6/10
N2 - 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.
AB - 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.
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U2 - 10.1136/heartjnl-2016-309442
DO - 10.1136/heartjnl-2016-309442
M3 - Article
C2 - 27288277
AN - SCOPUS:84978955258
JO - Heart
JF - Heart
SN - 1355-6037
ER -