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Published on: January 14, 2014
A propensity-matched analysis of cardiac operation in patients with and without cardiac amyloidosis
Akshay Chauhan1, Kevin L Greason1, Daniel D Borgeson2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Insights
Cardiac amyloidosis patients undergoing surgery have similar early outcomes and 1-year survival compared to controls. These findings suggest cardiac amyloidosis should not contraindicate necessary cardiac operations.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Limited data exist on cardiac surgery outcomes for patients with cardiac amyloidosis.
- Cardiac amyloidosis can affect cardiac function and surgical risk.
- Assessing surgical outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the impact of cardiac amyloidosis on early and late outcomes of routine cardiac operations.
- To compare complication rates and survival between patients with and without cardiac amyloidosis undergoing cardiac surgery.
Main Methods:
- A retrospective, propensity-matched, case-control study was conducted.
- Patients with cardiac amyloidosis (amyloid group) were matched with controls without known cardiac amyloidosis.
- Exclusions included heart transplantation and ventricular assist device implantation.
Main Results:
- 42 patients with cardiac amyloidosis were matched with 168 controls.
- Operative complication rates and need for mechanical support were similar between groups.
- No operative deaths occurred; 1-year survival was comparable (93% vs 89%).
Conclusions:
- Early procedural outcomes and 1-year survival are similar for patients with and without cardiac amyloidosis, provided cardiac function is preserved.
- Cardiac amyloidosis diagnosis should not be a contraindication for cardiac surgery.
- Long-term survival at 5 years was worse in the amyloid group, warranting further investigation.
Objective:
There are limited data on the outcome of routine cardiac operations in patients with cardiac amyloidosis. This study studied the impact of amyloidosis on early and late results of cardiac operations.
Methods:
This was a retrospective, propensity-matched, case-control study of patients with cardiac amyloidosis undergoing cardiac surgery. Heart transplantation and ventricular assist implantation were excluded. Controls were patients without known cardiac amyloidosis matched on baseline patient characteristics, echocardiographic findings, and type of operation. Outcomes included operative complications and survival.
Results:
In total, 42 patients with cardiac amyloidosis (amyloid group [AG]) were matched with 168 controls (CON group). The median left ventricular ejection fraction was 63% in the AG group (vs 64% CON). Aortic valve replacement and septal myectomy were the most common operations. Cardiopulmonary bypass (P = .374) and crossclamp (P = .185) times were similar in the 2 groups. Complication rates were similar in the 2 groups, including the need for mechanical circulatory support (n = 1 AG group vs n = 1 CON; P = .361) and intra-aortic balloon pump use (n = 3 AG group vs n = 13 CON; P = 1.000). There were no operative deaths. Survival was similar in the 2 groups at 1 year (AG 93% vs 89% CON; P = .1) but was worse in the AG at 5 years (59% vs 68% CON; P = .1).
Conclusions:
Early procedural outcomes and 1-year survival are similar in patients with and without cardiac amyloidosis with preserved cardiac function. Diagnosis of amyloidosis should not be a contraindication to cardiac surgery.
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