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



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.



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).



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.
Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland, Ohio, USA.
Ashwat
A
Dhillon
Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland, Ohio, USA.
Ashish
A
Khanna
Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland, Ohio, USA.
Mandeep Singh
MS
Randhawa
Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland, Ohio, USA.
Jacek
J
Cywinski
Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland, Ohio, USA.
Leif
L
Saager
Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland, Ohio, USA.
Maran
M
Thamilarasan
Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland, Ohio, USA.
Harry M
HM
Lever
Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland, Ohio, USA.
Milind Y
MY
Desai
D000368:Aged; D000758:Anesthesia / Q000009:adverse effects / Q000401:mortality; D001281:Atrial Fibrillation / Q000209:etiology; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D009820:Ohio; D010359:Patient Readmission; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome