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Ann Thorac Surg 1989;48:359-364
© 1989 The Society of Thoracic Surgeons

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Articles

Amiodarone-Induced Complications After Cardiac Operation for Obstructive Hypertrophic Cardiomyopathy

Surgery and Cardiology Branches, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland

Accepted for publication February 28, 1989.

^* Address reprint requests to Dr Clark, Surgery Branch, NHLBI, National Institutes of Health, 9000 Rockville Pike, Bldg 10, Room 2N244, Bethesda, MD 20892

The occurrence of unanticipated and seemingly unexplicable major complications of hepatic, pulmonary, and cardiac dysfunction after palliative operation for obstructive hypertrophic cardiomyopathy prompted a review of 71 sequential patients. Fifty-five patients had been treated preoperatively with β-blockers, calcium-channel inhibitors, or both, and 16 had received amiodarone for six to 566 days (mean time, 210 days) at total doses ranging from 8 to 175 g (mean dose, 82 g) and had drug-free intervals prior to operation of zero to 457 days (mean time, 91 days). Comparisons were made between the two treatment groups and between those with and without major complications within the amiodarone-treated group. Preoperative cardiac studies, sex, age, functional class, and type of operation were not related to outcome for the entire patient cohort. In amiodarone-treated patients, the major findings were as follows: a 50% incidence of hepatic dysfunction with a tenfold increase in concentrations of serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase; a 25% incidence of pulmonary dysfunction necessitating a fourfold increase in the number of days of ventilator support; and a 19% incidence of low cardiac output syndrome with two deaths. Only 44% of the amiodarone-treated group had no serious complications. The incidence of major complications of the liver, lungs, and heart was 2%, 0%, and 2%, respectively, in patients not treated with amiodarone. Abnormal preoperative pulmonary function studies were predictive of prolonged postoperative ventilatory support. Discontinuation of amiodarone for several months prior to operation appeared to reduce the incidence of major complications. The necessary drug-free interval required preoperatively could not be determined from this retrospective experience. The recommendations resulting from this analysis are as follows: amiodarone should be discontinued and the operation delayed for as long an interval as possible; any abnormality in liver or pulmonary function studies should delay the procedure; and patients and referring physicians should be informed of the probability of increased complications, especially if the treatment regimen included more than 100 g of amiodarone for 300 days or more. It is concluded that caution must be used when patients who have been treated with amiodarone are being considered for surgical palliation of obstructive hypertrophic cardiomyopathy.

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