Anesthetic implications of perioperative Takotsubo syndrome: a retrospective cohort study

Takotsubo syndrome is a reversible cardiomyopathy triggered by emotional or physical stressors. Although surgeries could be physical triggers, this has been scantily investigated. We aimed to describe the baseline characteristics, surgical/anesthesia-related triggering events, clinical presentation, and in-hospital outcomes of a cohort of patients diagnosed with perioperative Takotsubo syndrome.

In this retrospective study, we included all consecutive adult patients who were admitted to Hospital Italiano de Buenos Aires between 1 June 2008 and 30 November 2017 and diagnosed with Takotsubo syndrome according to the revised criteria of the European Society of Cardiology during hospitalization.

We diagnosed 21 patients with perioperative Takotsubo syndrome out of 305,906 patients undergoing procedures with anesthesia care. The median (interquartile range [IQR]) patient age was 75 (55-82) yr, and 16 (76%) were women. The median (IQR) left ventricular ejection fraction was 35 (35-42)% at diagnosis and 55 (46-55)% at discharge. Fifteen patients (71%) required inotropic/vasopressor support; however, this is a controversial treatment considering the physiopathology of the syndrome. Severe complications such as unexplained syncope/cardiac arrest, cardiogenic shock, and ventricular thrombus formation occurred in seven (33%) patients, and two (10%) patients died. These results were compared with 31 patients who experienced non-perioperative Takotsubo syndrome during the same period of time.

Perioperative Takotsubo syndrome is a reversible cardiomyopathy. Nevertheless, it seems to be associated with severe complications, the need for aggressive treatment, and non-negligible mortality.