title: Safety of Noncardiac Surgery in Patients With Hypertrophic Obstructive Cardiomyopathy at a Tertiary Care Center.
abstract: OBJECTIVE
  This study's purpose was to review non-cardiac surgery (NCS) in patients with hypertrophic obstructive cardiomyopathy (HOCM) to examine perioperative management and quantify postoperative mortality and worsening heart failure.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A single tertiary care center.
  
  
  METHODS
  The study included 57 adult patients with HOCM who underwent NCS from January 1, 1996, through January 31, 2014.
  
  
  METHODS
  Noncardiac surgery.
  
  
  RESULTS
  The authors identified 57 HOCM patients who underwent 96 NCS procedures. Vasoactive medications were administered to the majority of NCS patients. Three patients (3%) died within 30 days of NCS, but causes of death did not appear to be cardiac in nature. Death after NCS was not significantly associated with preoperative left ventricular ejection fraction (p = 0.2727) or peak instantaneous systolic resting gradient (0.8828), but was associated with emergency surgery (p = 0.0002). Three patients experienced worsening heart failure postoperatively, and this was significantly associated with preoperative New York Heart Association Class III-IV symptoms compared with I-II symptoms (p = 0.0008).
  
  
  CONCLUSIONS
  HOCM patients safely can undergo NCS at multidisciplinary centers experienced in caring for these patients. The mortality rate in this study was less than that reported in the majority of other studies. Postoperative complications, including increasing heart failure, may occur, especially in patients with more severe preoperative cardiac symptoms.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: David W
authors.initials: DW
authors.lastname: Barbara
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Hyder
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Travis L
authors.initials: TL
authors.lastname: Behrend
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Abel
authors.affiliation: Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN. Electronic address: Mauermann.William@mayo.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mauermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072080:Anesthesiologists; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000401:mortality; D005260:Female; D006323:Heart Arrest; D006333:Heart Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: anesthesia; heart failure; hypertrophic obstructive cardiomyopathy; mortality; non-cardiac surgery