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Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery
  1. Ashwat Dhillon1,
  2. Ashish Khanna2,
  3. Mandeep Singh Randhawa1,
  4. Jacek Cywinski2,
  5. Leif Saager2,
  6. Maran Thamilarasan1,
  7. Harry M Lever1,
  8. Milind Y Desai1
  1. 1Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland, Ohio, USA
  2. 2Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland, Ohio, USA
  1. Correspondence to Dr Milind Y Desai, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J1-5, Cleveland, OH 44195, USA; desaim2{at}ccf.org

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 non-cardiac 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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