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Gorji L, Brown ZJ, Limkemann A, Schenk AD, Pawlik TM. Liver Transplant as a Treatment of Primary and Secondary Liver Neoplasms. JAMA Surg 2024; 159:211-218. [PMID: 38055245 DOI: 10.1001/jamasurg.2023.6083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Importance Liver malignancies are an increasing global health concern with a high mortality. We review outcomes following liver transplant for primary and secondary hepatic malignancies. Observations Transplant may be a suitable treatment option for primary and secondary hepatic malignancies in well-selected patient populations. Conclusions and Relevance Many patients with primary or secondary liver tumors are not eligible for liver resection because of advanced underlying liver disease or high tumor burden, precluding complete tumor clearance. Although liver transplant has been a long-standing treatment modality for patients with hepatocellular carcinoma, recently transplant has been considered for patients with other malignant diagnoses. In particular, while well-established for hepatocellular carcinoma and select patients with perihilar cholangiocarcinoma, transplant has been increasingly used to treat patients with intrahepatic cholangiocarcinoma, as well as metastatic disease from colorectal liver and neuroendocrine primary tumors. Because of the limited availability of grafts and the number of patients on the waiting list, optimal selection criteria must be further defined. The ethics of organ allocation to individuals who may benefit from prolonged survival after transplant yet have a high incidence of recurrence, as well as the role of living donation, need to be further discerned in the setting of transplant oncology.
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Affiliation(s)
- Leva Gorji
- Department of Surgery, Kettering Health Dayton, Dayton, Ohio
| | - Zachary J Brown
- Division of Surgical Oncology, Department of Surgery, New York University-Long Island, Mineola
| | - Ashley Limkemann
- Division of Transplant, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Austin D Schenk
- Division of Transplant, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus
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von Mackensen JKR, Zwaans VIT, El Shazly A, Van Praet KM, Heck R, Starck CT, Schoenrath F, Potapov EV, Kempfert J, Jacobs S, Falk V, Wert L. Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review. J Clin Med 2024; 13:473. [PMID: 38256608 PMCID: PMC10816930 DOI: 10.3390/jcm13020473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. METHODS A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. RESULTS A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). CONCLUSIONS Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.
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Affiliation(s)
- Johanna K. R. von Mackensen
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
| | - Vanessa I. T. Zwaans
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
| | - Ahmed El Shazly
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
| | - Karel M. Van Praet
- Department of Cardiothoracic Surgery, ASZ Hospital Aalst, 9300 Aalst, Belgium
- Cardiac Surgery Department, Hartcentrum OLV Aalst, 9300 Aalst, Belgium
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
| | - Christoph T. Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site, 10785 Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site, 10785 Berlin, Germany
| | - Evgenij V. Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site, 10785 Berlin, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site, 10785 Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site, 10785 Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site, 10785 Berlin, Germany
- Department of Cardiothoracic Surgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Department of Health Sciences and Technology, ETH Zürich, 8093 Zurich, Switzerland
| | - Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute, 13353 Berlin, Germany; (V.I.T.Z.); (A.E.S.); (R.H.); (C.T.S.); (F.S.); (E.V.P.); (J.K.); (S.J.); (V.F.); (L.W.)
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Altaş Y, Abdullayeva Ü. Case of takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst: A case report. World J Clin Cases 2023; 11:7187-7192. [PMID: 37946773 PMCID: PMC10631423 DOI: 10.12998/wjcc.v11.i29.7187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy, also called apical ballooning syndrome, is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome. The aim of this article is to draw attention to takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst. CASE SUMMARY A 50-year-old diabetic and hypertensive female patient was evaluated preoperatively before general surgery for liver hydatid cyst, and no cardiac problems were found. The patient was discharged on the 3rd postoperative day without any postoperative complications. On postoperative day 5, the patient presented to the emergency department with fever, shortness of breath, chills, and shivering and was hospitalized with the diagnosis of pneumonia. The troponin levels remained high during follow-up. Echocardiography was performed on postoperative day 7, after which the patient was referred to a tertiary center with the diagnosis of non-ST-elevation myocardial infarction due to akinesia in the apical region. Coronary angiography performed at the tertiary center showed normal coronary anatomy, and the patient was diagnosed with takotsubo cardiomyopathy. CONCLUSION Takotsubo cardiomyopathy mimicking myocardial infarction without ST segment elevation may develop after surgical treatment of liver hydatid cyst.
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Affiliation(s)
- Yakup Altaş
- Department of Cardiology, Private Melikgazi Hospital, Kayseri 38030, Turkey
| | - Ülfet Abdullayeva
- Department of General Surgery, Private Melikgazi Hospital, Kayseri 38030, Turkey
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Bachayev M, Brereton B, Mondal A, Alli-Ramsaroop BA, Dhakal R, Leon MCB, Quinones CM, Abdelal MEO, Jain A, Dhaduk K, Desai R. Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports. Transplant Proc 2023:S0041-1345(22)00778-3. [PMID: 36858907 DOI: 10.1016/j.transproceed.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) has been reported in solid-organ transplant recipients. However, the pooled data regarding TTS after liver transplant remain limited. METHODS A systematic review was performed through February 2022 using PubMed, Embase, Scopus, and Google Scholar to review case reports/series and original studies on liver transplant-associated TTS. Descriptive analysis was performed for case reports and pooled analysis for the prevalence using random effects models. RESULTS A total of 56 case reports were included from 30 articles (51.8 % male; mean age, 53 years; India 56%, US 27%, and Europe 8.93%) and 10 original studies (US 88.65%, India 10.92%) revealing liver transplant-associated TTS. The pooled prevalence of TTS was 1.1% (95% Cl, 0.6%-1.7%) of all liver transplants with comparable rates in studies from India and the US (P = .92). Indications for liver transplant included end-stage liver disease due to alcohol-related cirrhosis (25%), hepatitis C virus infection (17.9%), hepatocellular carcinoma (10.7%), and non-alcohol-related steatohepatitis (8.9%); the average Model for End-Stage Liver Disease score was 24.75. TTS commonly presented as hypotension (30%), dyspnea (14%), and oliguria, occurring mostly post-transplant (82%), whereas 14% were intraoperative. Common electrocardiogram findings were ST changes, ventricular tachycardia, and atrial fibrillation. Common echocardiogram findings showed left ventricular apical ballooning in 46.5% of cases and reduced ejection fraction < 20% in 41.9% of cases. Common complications were cardiogenic shock (32.1 %), acute kidney injury (12.5%), arrhythmia, stroke, cardiac arrest, and hepatic artery thrombosis. Mechanical circulatory support was required in 30.3%. Recurrence was reported in 15, and mortality in 30.4% of patients. CONCLUSIONS Takotsubo syndrome prevalence after liver transplant is significantly higher than TTS prevalence in general US hospitalizations with potentially worse outcomes. Prospective registries reporting TTS in liver transplant recipients are warranted.
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Affiliation(s)
- Milana Bachayev
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Brian Brereton
- Department of Medicine, Jersey General Hospital, Saint Helier, Jersey
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, Pennsylvania
| | | | - Roshan Dhakal
- Department of Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Maria C Buhl Leon
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Camila M Quinones
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Mohamed Eyad O Abdelal
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Kartik Dhaduk
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pennsylvania.
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Montone RA, La Vecchia G, Buono MGD, Abbate A, Sanna T, Pedicino D, Niccoli G, Antonelli M, Crea F. Takotsubo Syndrome in Intensive Cardiac Care Unit: Challenges in Diagnosis and Management. Curr Probl Cardiol 2021; 47:101084. [PMID: 34942270 DOI: 10.1016/j.cpcardiol.2021.101084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023]
Abstract
Takotsubo syndrome (TTS) is an acute reversible form of myocardial dysfunction that is often associated with serious adverse in-hospital complications, including acute heart failure, cardiogenic shock and life-threatening arrythmias. In the absence of randomized clinical trials, its management in the acute phase is based on empirical supportive pharmacological and non-pharmacological measures.In this review article, we aimed at providing an overview of the acute clinical manifestations of patients presenting with TTS, highlighting the predictors of a worse short-term outcome, along with the challenges in therapeutic management of TTS-related complications in the acute care setting.
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Affiliation(s)
- Rocco Antonio Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond
| | - Antonio Abbate
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Fondazione 'Policlinico Universitario A. Gemelli' IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Sharma S, Sonny A, Dalia AA, Karamchandani K. Acute heart failure after liver transplantation: A narrative review. Clin Transplant 2020; 34:e14079. [PMID: 32941661 DOI: 10.1111/ctr.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/27/2020] [Indexed: 11/27/2022]
Abstract
Acute heart failure (AHF) is an under recognized yet potentially lethal complication after liver transplantation (LT) surgery. The increase in incidence of liver transplantation amongst high-risk patients and the leniency in the criteria for transplantation, predisposes these patients to postoperative AHF and the antecedent morbidity and mortality. The inability of conventional preoperative cardiovascular testing to accurately identify patients at risk for post-LT AHF poses a considerable challenge to clinicians caring for these patients. Even if high-risk patients are identified, there is considerable ambiguity in the candidacy for transplantation as well as optimization strategies that could potentially prevent the development of AHF in the postoperative period. The intraoperative and postoperative management of patients who develop AHF is also challenging and requires a well-coordinated multidisciplinary approach. The use of mechanical circulatory support in patients with refractory heart failure has the potential to improve outcomes but its use in this complex patient population can be associated with significant complications and requires a stringent risk-benefit analysis on a case-by-case basis.
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Affiliation(s)
- Sonal Sharma
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Abraham Sonny
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kunal Karamchandani
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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Luu LA, Rawashdeh B, Goldaracena N, Agarwal A, McCracken EK, Sahli ZT, Oberholzer J, Pelletier SJ. Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation - Which Came First? AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920263. [PMID: 32287173 PMCID: PMC7176589 DOI: 10.12659/ajcr.920263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. CASE REPORT The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. CONCLUSIONS It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.
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Affiliation(s)
- Lydia A Luu
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Badi Rawashdeh
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Nicolas Goldaracena
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Avinash Agarwal
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Emily K McCracken
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Zeyad T Sahli
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Jose Oberholzer
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
| | - Shawn J Pelletier
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
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Maestas C, Lazkani M, Sultan M, Kolli G, Sheikh M, Cherukuri M. Severe takotsubo cardiomyopathy following orthotopic liver transplantation: A case series. Clin Res Hepatol Gastroenterol 2019; 43:e48-e53. [PMID: 30853493 DOI: 10.1016/j.clinre.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acute decompensated heart failure is a known complication following orthotopic liver transplant. Among those, there are some cases of takostubo type cardiomyopathy (TC), commonly referred to as "broken heart syndrome". While the exact mechanism of TC is unknown, it frequently proceeds a physical or emotional stressor. Here we present a series of seven cases of TC following orthotopic liver transplant. METHODS A retrospective chart review was conducted on 454 patients were identified as having post-operative cardiac dysfunction in the setting of orthotopic liver transplantation. Of those, seven were identified as having TC based on apical ballooning, acute heart failure without evidence of coronary artery disease. All seven underwent pre-operative cardiac evaluation per protocol. Extensive chart review was performed on the seven patients to identify pre and post-operative qualities. RESULTS At this single institution, TC affected 7/454 patients, reflecting an incidence of 1.5% over the eight year study period. Of the seven patients affected, one expired. Patients represented a mix of emergent and scheduled transplantation in the setting of end stage liver disease (ESLD). Patients had a mix of etiologies related to their ELSD including hepatitis C, alcoholic cirrhosis, and non-alcoholic steatohepatitis. DISCUSSION It is important to recognize TC as a potential complication following liver transplantation so as to detect cases earlier in the disease course and begin early goal-directed care.
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Affiliation(s)
- Camila Maestas
- Internal Medicine Resident, Department of Internal Medicine, Banner University Medical Center-Phoenix, Arizona 85006, USA.
| | - Mohamad Lazkani
- Structural Heart Fellow, Department of Cardiology, Banner University Medical Center-Phoenix, Arizona 85006, USA.
| | - Michael Sultan
- Cardiovascular Disease Fellow, Department of Cardiology, Banner University Medical Center-Phoenix, Arizona 85006, USA.
| | - Geetha Kolli
- Attending Physician, Hepatology, Department of Gastroenterology, Banner University Medical Center-Phoenix, Arizona 85006, USA.
| | - Maheen Sheikh
- Attending Physician, Department of Gastroenterology, Banner University Medical Center-Phoenix, Arizona 85006, USA.
| | - Madhavgopal Cherukuri
- Attending Physician, Interventional Cardiology, Department of Cardiology, Banner University Medical Center-Phoenix, Arizona 85006, USA.
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Stöllberger C, Schneider B, Finsterer J. Does autonomic re-innervation cause Takotsubo syndrome in a transplanted heart? Comment on: "Takotsubo cardiomyopathy in a young adult with transplanted heart: what happened to denervation?" by Chinali et al. ESC Heart Fail 2018; 5:1197-1198. [PMID: 30106510 PMCID: PMC6300818 DOI: 10.1002/ehf2.12318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/30/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Claudia Stöllberger
- Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030, Vienna, Austria.,Steingasse 31/18, A-1030, Vienna, Austria
| | | | - Josef Finsterer
- Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030, Vienna, Austria
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10
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Perioperative Stress-Induced (Takotsubo) Cardiomyopathy in Liver Transplant Recipients. ACTA ACUST UNITED AC 2018; 4:56-63. [PMID: 30581996 PMCID: PMC6294992 DOI: 10.2478/jccm-2018-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022]
Abstract
A comprehensive analysis of published cases of Takotsubo cardiomyopathy, occurred in liver transplant recipients in the perioperative period, has been attempted in this review. Predisposing factors, precipitating events, potential physiological mechanisms, acute and post-event management have been discussed.
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Dalia AA, Flores A, Chitilian H, Fitzsimons MG. A Comprehensive Review of Transesophageal Echocardiography During Orthotopic Liver Transplantation. J Cardiothorac Vasc Anesth 2018; 32:1815-1824. [PMID: 29573952 DOI: 10.1053/j.jvca.2018.02.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 12/14/2022]
Abstract
Orthotopic liver transplantation (OLT) is characterized by significant hemodynamic disturbances and anesthetic challenges. Intraoperative transesophageal echocardiography (TEE) can be used to guide management during these procedures. This review examines the role of echocardiography during OLT, presents common TEE findings during each phase of OLT, and discusses the benefits demonstrated with TEE use and the safety of TEE in this patient population. Finally, the authors propose an algorithm for the safe use of TEE during OLT.
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Affiliation(s)
- Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Antolin Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hovig Chitilian
- Department of Anesthesiology, Pain Medicine, and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael G Fitzsimons
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation. J Transplant 2018; 2018:9739236. [PMID: 29670765 PMCID: PMC5835255 DOI: 10.1155/2018/9739236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/03/2017] [Accepted: 12/14/2017] [Indexed: 02/07/2023] Open
Abstract
Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo's Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure.
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Aalberts JJJ, Klinkenberg TJ, Mariani MA, van der Harst P. Mechanical circulatory support for refractory cardiogenic shock in Takotsubo syndrome: a case report and review of the literature. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx005. [PMID: 31020064 PMCID: PMC6176877 DOI: 10.1093/ehjcr/ytx005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/20/2017] [Indexed: 02/02/2023]
Abstract
Takotsubo syndrome (TTS) complicated by refractory cardiogenic shock is a challenging clinical problem, as treatment with inotropic agents and/or vasopressors is contraindicated. We illustrate this by a patient presenting with chest pain and shortness of breath caused by TTS complicated by cardiogenic shock requiring mechanical circulatory support (MCS). The patient received central extracorporeal life support with a cannula in the left atrium (pre-load reduction of left ventricle) and the return cannula in the ascending aorta (neutral on afterload). Treatment with MCS was complicated by a cardiac tamponade. Left ventricular function recovered after 24 h, and the patient was doing well at the outpatient clinic 7 weeks after discharge. In addition, we reviewed the literature (PubMed search) reporting on MCS in patients with TTS. Including our patient, 17 cases of TTS induced cardiogenic shock receiving MCS have been reported. Age of the patients ranged from 16 years to 74 years, and 71% of the patients were female. Extracorporeal life support was the most used type of MCS (82% of the cases). Two patients died, and complications of MCS were rare (one case of leg ischaemia). Theoretically, MCS devices that reduce pre-load and are neutral on afterload are preferable. However, no specific type of MCS can be recommended as randomized trials are lacking. In conclusion, our case and the available literature suggests that MCS in TTS induced refractory cardiogenic shock is an immediate and feasible lifesaving treatment.
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Affiliation(s)
- Jan J J Aalberts
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, RB Groningen, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, RB Groningen, The Netherlands
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