Hypertrophic Obstructive Cardiomyopathy Clinical Trial
Official title:
Perioperative Risk Factors of Postoperative Complications in Hypertrophic Obstructive Cardiomyopathy Patients Undergoing Septal Myectomy
Perioperative management may have strong connections with postoperative complications (PCs). However, little is known about the perioperative risk factors of PCs after septal myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients. This study is designed to assess the in-hospital PCs rate of HOCM patients and to identify perioperative risk factors of PCs in patients who underwent septal myectomy. Retrospective chart review will identify adult HOCM patients who underwent septal myectomy from October 2013 to December 2018 in the investigators' hospital. Patients' data will be collected from electronic medical records. The multivariable logistic regression analysis will be used to determine independent predictors. The predictive ability of individual predictor and different combination of multiple risk factors on PCs will also be calculated.
This study is a single center retrospective observational study designed to assess the
in-hospital PCs rate of HOCM patients and to identify perioperative risk factors of PCs in
patients who underwent septal myectomy.
Ethical approval of this study was obtained from the Institutional Review Board of the
investigators' hospital (No. KY20192036-C-1). The requirement for written informed consent
was waived by the Institutional Review Board, considering the retrospective nature of the
study.
Retrospective chart review will identify adult HOCM patients who underwent septal myectomy
from October 2013 to December 2018 in the investigators' hospital. The clinical diagnosis of
HOCM is made by echocardiography, cardiac magnetic resonance imaging, or computed tomography
of a hypertrophied, non-dilated LV, in the absence of cardiac or systemic disease that can
aggravate the magnitude of hypertrophy.
Data Collection
The following data will be collected. Data will be obtained from electronic medical records
and collected by two trained staff who are unaware of the purpose of the study.
1. Demographic and clinical data included New York Heart Association class, family history
of hypertrophic cardiomyopathy (HCM) and sudden death, patient history, symptoms,
medications, and comorbidities of these enrolled patients.
2. The following preoperative echocardiographic parameters will be collected : left atrium
diameter, left ventricular (LV) ejection fraction (EF), maximal LV wall thickness
(defined as the greatest thickness measured at any site within the LV wall), maximal
interventricular septal thickness, left ventricular outflow tract diameter (LVOTd)
(C-sept distance, the shortest distance from the septum to the coaptation point of the
mitral valve), and resting left ventricular outflow tract (LVOT) gradient (measured with
continuous-wave Doppler in the apical five-chamber view using the modified Bernoulli
equation).
3. Intraoperative data collected include the duration of anaesthesia, surgery, CPB, and
cross-clamp; excised LV weight; type of concomitant procedure; lowest body temperature,
haematocrit , haemoglobin and highest Lactic acid; perioperative fluid management
including the volumes of total fluid intake, total output and intraoperative fluid
balance (total intraoperative fluid intake is calculated as the sum of crystalloid,
colloid and blood products; total output was calculated as the sum of the volumes of
estimated blood loss and urine output; intraoperative fluid balance is calculated by
subtracting the total output from the total fluid intake); and blood pressure parameters
including the baseline mean arterial pressure and lowest mean arterial pressure, and
duration of intraoperative hypotension (intraoperative hypotension is defined as a mean
arterial pressure <65 mmHg).
4. Postoperative ventilation hours, lengths of stay in the intensive care unit (ICU) and
hospital, blood transfusion in 72 hours after surgery, EF, LVOTd, resting LVOT gradient
gradient, and in-hospital PCs will also be obtained. In-hospital PCs include all-cause
mortality, heart failure, low cardiac output syndrome, stroke, spinal cord injury, acute
respiratory distress syndrome, reintubation, reoperation, permanent implantable
cardioverter defibrillator, kidney injury, renal failure, liver injury, and liver
failure.
Statistical analysis
Continuous variables will be expressed as mean ± standard deviation (SD) or median
(interquartile range). Differences of continuous variables will be analysed by using a
parametric unpaired Student's t-test or non-parametric Mann-Whitney U-test, as appropriate.
Categorical variables will be described as percentages (%) and compared using the chi-square
test or Fisher's exact test. For all analyses, a two-tailed P-value <0.05 will be considered
statistically significant. The multivariable model will be used to determine independent
predictors by including only variables that are identified by univariable analysis as
significant prognosis risk factors with a P-value <0.05. Receiver operating characteristic
curve will be used to calculate the cut off values of individual risk factors. The predictive
ability of individual predictor and different combination of multiple risk factors on PCs
will also be calculated. SPSS software version 22.0 (IBM Corp., Armonk, NY, USA) will be used
to analyse the data.
Privacy
All data collected in this study will be stored on computer systems that require user
authentication for log on. After data collection is complete, none of this electronic data
will be stored with subject-identifying information and will be archived and kept
indefinitely.
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