Safety of Noncardiac Surgery in Patients With Hypertrophic Obstructive Cardiomyopathy at a Tertiary Care Center

Perioperative outcomes of hypertrophic cardiomyopathy: An insight from the National Readmission Database

BACKGROUND

Data regarding hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing noncardiac surgery is lacking. We sought to examine the perioperative outcomes of HOCM patients undergoing noncardiac surgery using a national database.

METHODS

We used the National readmission database from 2016 to 2019. We identified HOCM, heart undergoing noncardiac surgery using ICD 10 codes. We examined hospital outcomes as well as 90 days readmission outcomes.

RESULTS

We identified 16,098 HOCM patients and 21,895,699 non-HOCM patients undergoing noncardiac surgery. The HOCM group had more comorbidities at baseline. After adjustment for major clinical predictors, the HOCM group experienced more in-hospital death, odds ratio (OR) 1.33 (1.216-1.47), P < 0.001, acute myocardial infarction (AMI), OR 1.18 (1.077-1.292), P < 0.001, acute heart failure odds ratio OR 1.3 to (1.220-1.431), P < 0.001, 90 days readmission OR 1.237 (1.069-1.432), P < 0.01, cardiogenic shock OR 2.094 (1.855-2.363), P < 0.001. Cardiac arrhythmia was the most common cause of readmission, out of the arrhythmias atrial fibrillation was the most prevalent. Acute heart failure was the most common complication of readmission. There was no difference in major adverse cardiovascular events (MACE), and AMI between both groups and readmission.

CONCLUSION

HOCM patients undergoing noncardiac surgery may be at increased risk of in-hospital and readmission events. Acute heart failure was the most common complication during index admission, while cardiac arrhythmias were the most common complication during readmission. More research is needed to address this patient population further.

Severe unprovoked hypertrophic obstructive cardiomyopathy: anaesthetic concerns in patient undergoing parathyroidectomy

This case highlights the role of an anaesthetist as a perioperative physician involved in diagnosing and optimising asymptomatic but severe hypertrophic obstructive cardiomyopathy. The modifications in anaesthetic technique for safe conduct of general anaesthesia during parathyroidectomy in a patient are also presented. These include those due to an extremely high left ventricular outflow tract obstruction with echocardiographic Doppler-derived maximum pressure gradient of 105 mm Hg at rest.

Preoperative echocardiography as a prognostic tool for liver transplant in patients with hypertrophic cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) presents with a hypertrophied left ventricle (LV). It is often associated with LV outflow tract obstruction (LVOTO) and a risk for sudden death. This study aimed to describe outcomes of patients with HCM who underwent liver transplant (LT).

METHODS

A retrospective review was conducted for patients diagnosed with HCM undergoing LT. Patient characteristics, preoperative echocardiography results, HCM risk of sudden cardiac death prediction model score, and 5-year mortality were examined. A univariable Cox proportional hazards model was used to evaluate the association between risk factors and 5-year mortality. All tests were two-sided with the alpha level set at .05.

RESULTS

Twenty-nine patients were included in the analysis. Six patients (21%) had a perioperative cardiopulmonary complication. The 5-year survival rate was 61% (95% CI, 45-82). The analyzed risk factors showed that 5-year post-LT survival was significantly predicted by maximal LV outflow tract gradient at rest > 60 mmHg (hazard ratio, 1.04 [95% CI, 1.01-1.06]).

CONCLUSIONS

Preoperative LV outflow tract resting gradient > 60 mmHg was associated with 5-year post-LT mortality. The results suggest the severity of LVOTO identified by echocardiography is a prognostic tool for patients with HCM after LT.

Hypertrophic cardiomyopathy surgery: Perioperative anesthetic management with two different and combined techniques

Hypertrophic cardiomyopathy (HOCM) is the most common genetic heart disorder and the most common cause of sudden cardiac death among young population and a major cause of disability for patients of any age. An extended transaortic septal myectomy is the definitive treatment. It is very important to have a good knowledge of the characteristic pathophysiology of the disease in order to optimize intraoperative treatment of these patients. We present a case of a 68-year old woman who underwent hypertrophic elective cardiomyopathy surgery. Anesthetic management is crucial to guarantee maximum safety, since HOCM has the capacity to produce hemodynamic events of such severity that put patient's life at risk. The use and combination of intraoperative transesophageal echocardiography (TEE) and direct measurement of the left ventricular outflow tract gradient provides vital information to ensure successful surgical outcome in patients with HOCM.

Short- and Long-Term Outcomes of Patients With Hypertrophic Cardiomyopathy After Noncardiac Surgery: A Single-Center Retrospective Study

OBJECTIVE

Although several studies have demonstrated that noncardiac surgery in patients with hypertrophic cardiomyopathy (HCM) is safe, the long-term outcomes remain unclear. Therefore, the authors investigated the postoperative long-term outcomes of patients with HCM who underwent noncardiac surgery at their hospital.

DESIGN

Retrospective review.

SETTING

Single university hospital.

PARTICIPANTS

Seventy-two consecutive patients with HCM who underwent noncardiac surgery.

INTERVENTION

No intervention.

MEASUREMENTS AND MAIN RESULTS

The incidence of HCM-related events during the patient's hospital stay were evaluated as the short-term outcomes, and HCM-related events after discharge were evaluated as the long-term outcomes. HCM-related events were defined as sudden death, implantable cardioverter-defibrillator discharge with successful recovery from cardiopulmonary arrest, death due to heart failure, hospitalization for heart failure, myocardial infarction, and thrombosis caused by atrial fibrillation. The median postoperative follow-up was 1,382 days (3.8 years). Short-term mortality and morbidity rates were both 1.3%, whereas long-term mortality and morbidity rates were 4.2% and 15%, respectively. The 5-year event-free rate was 76%, whereas the postoperative HCM-related mortality rate was 4.2%.

CONCLUSIONS

This study suggests that noncardiac surgery in patients with HCM is safe in terms of both short- and long-term outcomes. To confirm the findings, additional studies, such as prospective, multicenter, observational studies, should be conducted.