2025 FSA Podium and Poster Abstracts

Background: Anecdotally, patients with amyloidosis present a significant risk in the perioperative period. There are two major types of amyloidosis that have significant cardiovascular involvement, transthyretin (ATTR) and light chain (AL), and therefore patients may experience hemodynamic instability during surgery. Transthyretin amyloidosis can be either hereditary (h-ATTR) or a wild-type variant (wt-ATTR) in which the latter is being increasingly recognized in the last 20 years due to advances in non-invasive testing. Patients with light chain amyloidosis (AL) have oncologic considerations as well. Because recognition of cardiac amyloidosis is more common and there have been advancements in available treatments, patients are more frequently presenting to surgery with this disease. However, there have been no significant studies related to procedural outcomes aside from case reports and case series in small, specific populations. With a relatively large patient cohort, the aim of this study was to evaluate demographic data in patients with cardiac amyloidosis, describe the most commonly performed procedures, and assess the significance of postoperative outcomes. 

Methods: Data from 485 patients with amyloidosis who underwent a range of procedures were analyzed. Demographic characteristics, including age, sex, and race, were recorded, along with the type of procedure (minimally invasive vs invasive). We assessed complications such as prolonged hospital stays (>2 days), ICU admission after procedure, readmissions within 30 days, postoperative bleeding requiring transfusions, vasopressor/inotrope use, arrhythmias, and 30-day mortality. Additionally, the analysis considered commonly associated demographic variables and analysis of the impact of amyloid type on postoperative outcomes.  

Results: The study cohort had a median age of 69.5 years, with a majority being male (71%) and White (78.4%). The most common procedures were endoscopy (25.6%) and bone marrow biopsies (10.1%), followed by other interventional procedures. ICU admissions were significantly higher in patients undergoing invasive procedures compared to minimally invasive procedures, with an odds ratio (OR) of 22.09 (p = 0.007). Additionally, patients who underwent invasive procedures had a higher rate of prolonged hospitalization, with an OR of 2.89 (p < 0.001).  

The need for vasopressors/inotropes within 30 days of the procedure was notably higher in patients undergoing invasive interventions, with an OR of 16.98 (p = 0.008). Readmissions within 30 days were 9.9%, and mortality across both types of procedures was 1.6%, indicating significant associated complications with mostly low risk surgeries. (Table 3A) 

No significant differences in postoperative complications, including reintubation rates, arrhythmias, or 30-day mortality, were found between patients with ATTR and AL amyloidosis. (Table 3B)

Conclusion: This study highlights that procedural adverse events in patients with amyloidosis are relatively common. It also suggests that the type of amyloid may not affect outcomes, although there was a nonsignificant trend toward worsened perioperative mortality in patients with AL. The results also emphasize that there is increased risk with more complex interventions. These findings suggest the need for perioperative teams to be aware of the risks in these patients, though further studies are needed to identify additional risk factors for complications in this population