Perioperative outcomes of pheochromocytoma/paraganglioma surgery preceded by Takotsubo-like cardiomyopathy.

Adrenal Gland Neoplasms / complications Cardiomyopathies / complications Humans Medical History Taking Middle Aged Paraganglioma / complications Pheochromocytoma / surgery

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
09 2022
Historique:
received: 16 09 2021
revised: 08 02 2022
accepted: 05 04 2022
pubmed: 20 5 2022
medline: 18 8 2022
entrez: 19 5 2022
Statut: ppublish

Résumé

Pheochromocytomas and paragangliomas can induce severe cardiovascular manifestations such as Takotsubo-like cardiomyopathy. What the perioperative outcomes are of patients presenting with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy remains an unresolved question. From 2006 to 2019, all patients who underwent surgery for pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy were included from 3 high-volume centers, with specific attention to perioperative hemodynamic instability and postoperative outcomes. Overall, 37 patients were included, with a median age of 45 years. Patients were operated on 2 months (1-4) after a Takotsubo-like cardiomyopathy episode; 33 (89%) had a laparoscopic approach. All those who underwent surgery presented in a hemodynamically stable situation. All except 1 of the pheochromocytomas/paragangliomas patients had at least 1 antihypertensive treatment at the time of surgery. The median preoperative systolic blood pressure in the Takotsubo-like cardiomyopathy group was 120 mm Hg (95-132). Overall, 27/34 (79%) of patients required vasoactive drugs during surgery with nicardipine (n = 22), esmolol (n = 12), and/or norepinephrine (n = 8). No patient presented a catecholamine-induced life-threatening complication such as hypertensive crisis, cardiac arrhythmias, pulmonary edema, cardiac ischemia, or Takotsubo-like cardiomyopathy in the perioperative period. Severe morbi-mortality was nil. The systematic review identified 5 studies including 38 pheochromocytomas/paragangliomas patients with at least 1 episode of acute heart failure considered as Takotsubo-like cardiomyopathy before surgery, of which 28 patients had delayed surgery with 1 postoperative death. Hemodynamically stabilized patients with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy can be safely scheduled for an elective pheochromocytomas/paragangliomas surgery, with similar intra and postoperative outcomes as those without Takotsubo-like cardiomyopathy.

Sections du résumé

BACKGROUND
Pheochromocytomas and paragangliomas can induce severe cardiovascular manifestations such as Takotsubo-like cardiomyopathy. What the perioperative outcomes are of patients presenting with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy remains an unresolved question.
METHODS
From 2006 to 2019, all patients who underwent surgery for pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy were included from 3 high-volume centers, with specific attention to perioperative hemodynamic instability and postoperative outcomes.
RESULTS
Overall, 37 patients were included, with a median age of 45 years. Patients were operated on 2 months (1-4) after a Takotsubo-like cardiomyopathy episode; 33 (89%) had a laparoscopic approach. All those who underwent surgery presented in a hemodynamically stable situation. All except 1 of the pheochromocytomas/paragangliomas patients had at least 1 antihypertensive treatment at the time of surgery. The median preoperative systolic blood pressure in the Takotsubo-like cardiomyopathy group was 120 mm Hg (95-132). Overall, 27/34 (79%) of patients required vasoactive drugs during surgery with nicardipine (n = 22), esmolol (n = 12), and/or norepinephrine (n = 8). No patient presented a catecholamine-induced life-threatening complication such as hypertensive crisis, cardiac arrhythmias, pulmonary edema, cardiac ischemia, or Takotsubo-like cardiomyopathy in the perioperative period. Severe morbi-mortality was nil. The systematic review identified 5 studies including 38 pheochromocytomas/paragangliomas patients with at least 1 episode of acute heart failure considered as Takotsubo-like cardiomyopathy before surgery, of which 28 patients had delayed surgery with 1 postoperative death.
CONCLUSION
Hemodynamically stabilized patients with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy can be safely scheduled for an elective pheochromocytomas/paragangliomas surgery, with similar intra and postoperative outcomes as those without Takotsubo-like cardiomyopathy.

Identifiants

DOI: 10.1016/j.surg.2022.04.004 PMID: 35589436
pubmed: 35589436
pii: S0039-6060(22)00232-X
doi: 10.1016/j.surg.2022.04.004
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

913-918

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Élisabeth Hain (É)

Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Universite de Paris, Sorbonne Paris Cite, France.

Amine Chamakhi (A)

Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Tunis El Manar University, Tunis, Tunisia.

Charlotte Lussey-Lepoutre (C)

Sorbonne University, Paris, France; Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, APHP, Paris, France; INSERM, PARCC, Équipe Labellisée par la Ligue contre le Cancer; Genetics Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.

Jérôme Bertherat (J)

Universite de Paris, Sorbonne Paris Cite, France; Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; INSERM Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Paris, France.

Christophe Baillard (C)

Universite de Paris, Sorbonne Paris Cite, France; Department of Anesthesiology, Cochin Hospital, APHP, Paris, France.

Gilles Manceau (G)

Universite de Paris, Sorbonne Paris Cite, France; Department of Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.

Louis Puybasset (L)

Sorbonne University, Paris, France; Department of Anesthesiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.

Jacques Blacher (J)

Universite de Paris, Sorbonne Paris Cite, France; Department of Hypertension and Cardiovascular Prevention, Hotel Dieu Hospital, AP-HP, Paris, France.

Bernard Cholley (B)

Universite de Paris, Sorbonne Paris Cite, France; Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.

Anne-Paule Gimenez-Roqueplo (AP)

Universite de Paris, Sorbonne Paris Cite, France; INSERM, PARCC, Équipe Labellisée par la Ligue contre le Cancer; Genetics Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.

Bertrand Dousset (B)

Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Universite de Paris, Sorbonne Paris Cite, France.

Laurence Amar (L)

Universite de Paris, Sorbonne Paris Cite, France; INSERM, PARCC, Équipe Labellisée par la Ligue contre le Cancer; Genetics Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France; Hypertension Unit, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.

Fabrice Menegaux (F)

Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University, Paris, France.

Sébastien Gaujoux (S)

Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University, Paris, France. Electronic address: sebastien.gaujoux@aphp.fr.

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Classifications MeSH

questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs de la surrénale › Perioperative outcomes of...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Cardiomyopathies › Perioperative outcomes of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Perioperative outcomes of...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Recueil de l'anamnèse › Perioperative outcomes of...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Perioperative outcomes of...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu nerveux › Tumeurs neuroectodermiques › Tumeurs neuroendocrines › Paragangliome › Perioperative outcomes of...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu nerveux › Tumeurs neuroectodermiques › Tumeurs neuroendocrines › Paragangliome › Phéochromocytome › Perioperative outcomes of...