Kyung-Ho Chang1, Kazuo Hanaoka. 1. Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.
Abstract
BACKGROUND: A considerable amount of data are available regarding cardiac risk in patients with coronary artery disease, but not with patients with cardiomyopathy, undergoing non-cardiac surgery. METHODS: Reports of the anesthetic management of patients with dilated cardiomyopathy (DCM) undergoing non-cardiac surgery were identified using Medline and the Igaku-chuou-zassi (Japana Centra Revuo Medicina) database (1981-2001). The data were analyzed in terms of patient characteristics, methods of intraoperative care, and clinical outcome. RESULTS: Seventy-three patients were included. The mean value of the preoperative left ventricular ejection fraction (EF) was 31%. About 70% of patients revealed poor ventricular function (EF < 35%). EF did not correlate with the severity of congestive heart failure (CHF). Major complications occurred in 6 cases and minor ones in 23 cases. A history of CHF, advanced NYHA classification and lack of preoperative diagnosis of DCM were suggested as perioperative risk factors. CONCLUSIONS: Careful planning is inevitable in anesthesia for patients with DCM, although the rate of major perioperative complications is relatively low. Evaluation of cardiac reserve is more important than the resting value of ejection fraction. In order to clearly elucidate risk factors for adverse perioperative outcomes, further analysis will be necessary as more cases are documented.
BACKGROUND: A considerable amount of data are available regarding cardiac risk in patients with coronary artery disease, but not with patients with cardiomyopathy, undergoing non-cardiac surgery. METHODS: Reports of the anesthetic management of patients with dilated cardiomyopathy (DCM) undergoing non-cardiac surgery were identified using Medline and the Igaku-chuou-zassi (Japana Centra Revuo Medicina) database (1981-2001). The data were analyzed in terms of patient characteristics, methods of intraoperative care, and clinical outcome. RESULTS: Seventy-three patients were included. The mean value of the preoperative left ventricular ejection fraction (EF) was 31%. About 70% of patients revealed poor ventricular function (EF < 35%). EF did not correlate with the severity of congestive heart failure (CHF). Major complications occurred in 6 cases and minor ones in 23 cases. A history of CHF, advanced NYHA classification and lack of preoperative diagnosis of DCM were suggested as perioperative risk factors. CONCLUSIONS: Careful planning is inevitable in anesthesia for patients with DCM, although the rate of major perioperative complications is relatively low. Evaluation of cardiac reserve is more important than the resting value of ejection fraction. In order to clearly elucidate risk factors for adverse perioperative outcomes, further analysis will be necessary as more cases are documented.