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Long-Term Cardiovascular Complications in Patients With Pheochromocytomas and Paragangliomas After Surgery: A Large
Nan Guo1, Tao Liu2, Ping Zhao1
1Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Insights
Long-term cardiovascular complications are common after surgery for pheochromocytomas and paragangliomas (PPGLs). Key risk factors include the type of tumor, low ejection fraction, and postoperative hypertension, guiding better patient follow-up.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Pheochromocytomas and paragangliomas (PPGLs) cause excess catecholamines, impacting cardiovascular health.
- While surgery often resolves PPGLs, a significant subset of patients experience persistent cardiovascular issues.
- Identifying long-term risks post-surgery is crucial for patient management.
Purpose of the Study:
- To determine the incidence of long-term cardiovascular complications in patients after PPGLs surgery.
- To identify independent risk factors associated with these postoperative cardiovascular complications.
Main Methods:
- Retrospective review of 602 patients who underwent sporadic PPGLs surgery between 2012 and 2022.
- Data collection included demographics and perioperative details.
- Multiple logistic regression analysis was employed to identify risk factors.
Main Results:
- Over a median 64-month follow-up, 12.6% of patients developed long-term cardiovascular complications.
- Independent risk factors identified were pheochromocytomas, low preoperative left ventricular ejection fraction (LVEF), intraoperative hemodynamic instability (HDI), postoperative in-hospital cardiovascular complications, and persistent hypertension.
Conclusions:
- Long-term cardiovascular complications are a frequent occurrence in patients treated for PPGLs.
- Specific factors like tumor type, preoperative LVEF, intraoperative events, and postoperative hypertension predict these complications.
- These insights can inform improved surveillance and management strategies for post-surgical PPGLs patients.
Objective:
The effects of pheochromocytomas and paragangliomas (PPGLs)-induced catecholamine overproduction on vascular and cardiac function are generally thought to be reversible after PPGLs removal. However, a sizable proportion of patients who were free of the recurrent disease still faced high risks of cardiovascular problems after successful surgery. We aim to identify incidence and risk factors for long-term cardiovascular complications in PPGLs patients after surgery.
Design:
We retrospectively reviewed 602 patients who underwent surgery for sporadic PPGLs at three centers between January 2012 and October 2022. Demographic characteristics and perioperative data were recorded. Multiple logistic regression was used to determine the risk factors for postoperative long-term cardiovascular complications.
Results:
Finally, a total of 602 patients were included in the analysis, comprising 460 (76.4%) patients with pheochromocytomas and 142 (23.6%) patients with paragangliomas. After a median follow-up of 64 months, 76 (12.6%) patients had developed long-term cardiovascular complications. Independent risk factors included pheochromocytomas (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.425-11.965, p = 0.009), had low preoperative left ventricular ejection fraction (LVEF, OR = 5.659, 95% CI: 2.141-14.955, p < 0.001), experienced intraoperative hemodynamic instability (HDI, OR = 2.498, 95% CI: 1.423-4.385, p = 0.001), suffered from postoperative in-hospital cardiovascular complications (OR = 5.723, 95% CI: 2.078-15.758, p = 0.001) and long-term persistent hypertension (OR = 3.552, 95% CI: 1.580-7.988, p = 0.002).
Conclusions:
Long-term cardiovascular complications commonly occur in patients with surgical-cured PPGLs. Pheochromocytomas, had low preoperative LVEF, experienced intraoperative HDI, suffered from postoperative in-hospital cardiovascular complications, and persistent hypertension were determined as the risk factors for long-term cardiovascular complications. These findings may help to improve follow-up management.
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