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

David W Barbara1, Joseph A Hyder1, Travis L Behrend1

  • 1Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.

Journal of Cardiothoracic and Vascular Anesthesia
|December 26, 2015
PubMed

Insights

Patients with hypertrophic obstructive cardiomyopathy (HOCM) can undergo non-cardiac surgery (NCS) safely at experienced centers. While mortality is low, severe preoperative symptoms increase the risk of worsening heart failure post-surgery.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Cardiovascular Surgery

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents unique challenges for non-cardiac surgery (NCS).
  • Perioperative management and outcomes for HOCM patients undergoing NCS require careful consideration.

Purpose of the Study:

  • To review perioperative management strategies for patients with HOCM undergoing NCS.
  • To quantify postoperative mortality and the incidence of worsening heart failure in this population.

Main Methods:

  • Retrospective review of 57 adult patients with HOCM who underwent 96 NCS procedures at a single tertiary care center.
  • Data collected included perioperative management, mortality, and heart failure exacerbation.

Main Results:

  • The 30-day mortality rate was 3% (3 patients), with no deaths attributed to cardiac causes.
  • Emergency surgery was significantly associated with increased mortality (p = 0.0002).
  • Worsening heart failure was significantly associated with higher preoperative New York Heart Association functional class (p = 0.0008).

Conclusions:

  • Non-cardiac surgery can be performed safely in HOCM patients at specialized multidisciplinary centers.
  • The observed mortality rate was lower than reported in many previous studies.
  • Patients with more severe preoperative cardiac symptoms are at higher risk for postoperative heart failure complications.
Abstract

Keywords:
anesthesiaheart failurehypertrophic obstructive cardiomyopathymortalitynon-cardiac surgery

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