Departments of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
Departments of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
J Card Surg. 2021 Aug;36(8):2767-2773. doi: 10.1111/jocs.15626. Epub 2021 May 16.
Takotsubo syndrome following cardiac surgery is a rare occurrence. However, early diagnosis is essential to prevent treatment which could increase the left ventricular outflow tract pressure gradient in patients with Takotsubo syndrome, and lead to cardiogenic shock. Therefore, our study aimed to identify the incidence of Takotsubo syndrome after cardiopulmonary bypass and the associated risk factors and prognosis.
We retrospectively studied 5773 patients who underwent cardiopulmonary bypass between February 2007 and July 2017. Among these, Takotsubo syndrome was diagnosed in 52 (0.9%). To evaluate the risk factors for Takotsubo syndrome, 104 of the remaining 5721 patient were randomly selected as the control group (1:2 ratio). Univariate and multivariate logistic regression analyses were used for risk factor analysis.
Majority of patients (69.2%) in the Takotsubo syndrome group underwent mitral valve surgery, compared with 32.7% in the control group. The following risk factors of Takotsubo syndrome were identified: atrio-ventricular valve surgery (odds ratio (OR) 10.5; 95% confidence interval (CI), 2.6-42.5; p = 0.001); and the immediate postoperative use of epinephrine (OR, 3.3; 95% CI, 1.0-10.7; p = 0.05) and dobutamine (OR, 4.8; 95% CI, 1.72-13.3; p = 0.003). Hypertension was a significant protective factor against Takotsubo syndrome following cardiac surgery (OR, 0.22; 95% CI, 0.06-0.73; p = 0.01).
Takotsubo syndrome following cardiac surgery is rare. Immediate postoperative use of epinephrine and doputamine, as well as atrio-ventricular valve surgery were factors associated with the development of Takotsubo syndrome.
心脏手术后心尖球囊样综合征是一种罕见的情况。然而，早期诊断对于预防治疗至关重要，因为这种治疗可能会增加心尖球囊样综合征患者的左心室流出道压力梯度，导致心源性休克。因此，我们的研究旨在确定体外循环后心尖球囊样综合征的发生率以及相关的危险因素和预后。
我们回顾性研究了 2007 年 2 月至 2017 年 7 月期间接受体外循环的 5773 例患者。其中，52 例（0.9%）被诊断为心尖球囊样综合征。为了评估心尖球囊样综合征的危险因素，我们随机选择了 5721 例患者中的 104 例作为对照组（1:2 比例）。采用单因素和多因素逻辑回归分析进行危险因素分析。
心尖球囊样综合征组中大多数患者（69.2%）接受了二尖瓣手术，而对照组中这一比例为 32.7%。心尖球囊样综合征的以下危险因素包括房室瓣手术（比值比（OR）10.5；95%置信区间（CI）2.6-42.5；p=0.001）和术后立即使用肾上腺素（OR 3.3；95%CI 1.0-10.7；p=0.05）和多巴酚丁胺（OR 4.8；95%CI 1.72-13.3；p=0.003）。高血压是心脏手术后发生心尖球囊样综合征的显著保护因素（OR 0.22；95%CI 0.06-0.73；p=0.01）。
心脏手术后的心尖球囊样综合征很少见。术后立即使用肾上腺素和多巴酚丁胺以及房室瓣手术是与心尖球囊样综合征发生相关的因素。
