Intra-operative predictors of postoperative Takotsubo syndrome in liver transplant recipients-An exploratory case-control study

Clin Transplant. 2017 Nov;31(11). doi: 10.1111/ctr.13092. Epub 2017 Sep 14.

Abstract

Introduction: Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy or stress-induced cardiomyopathy, has been described following a variety of surgeries and disease states. The relationship between intra-operative anesthesia management and the development of this syndrome has never been fully elucidated.

Objectives: The primary objective of this study was to determine the relationship of multiple intra-operative factors on the pathogenesis of TTS.

Methods: A single-center retrospective review of all liver transplants performed at Mayo Clinic Florida from January 2005 to December 2014. Patients developing left ventricular dilation and a concomitant decrease in ejection fraction, a negative cardiac catheterization, or stress test within 30 days of transplantation were identified. Cases were matched 2:1 to controls with respect to MELD, age, sex, and indication for transplantation. Our evaluation included liver graft characteristics, intra-operative medications, and intra-operative hemodynamic measurements.

Results: We identified 24 cases of TTS from a pool of 1752 transplants, for an incidence of 1.4%. No statistically significant differences in intra-operative measures between the two groups were identified (all P ≥ .08).

Conclusion: Our exploratory, single-center retrospective review evaluating 46 intra-operative characteristics found no association with the development of TTS.

Keywords: Takotsubo; intra-operative characteristics; liver transplantation; stress-induced cardiomyopathy.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Graft Rejection / diagnosis
  • Graft Rejection / epidemiology
  • Graft Rejection / etiology*
  • Graft Survival
  • Humans
  • Incidence
  • Intraoperative Care*
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Takotsubo Cardiomyopathy / diagnosis
  • Takotsubo Cardiomyopathy / epidemiology
  • Takotsubo Cardiomyopathy / etiology*