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

  • Élisabeth Hain
    Affiliations
    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
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  • Amine Chamakhi
    Affiliations
    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
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  • Charlotte Lussey-Lepoutre
    Affiliations
    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
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  • Jérôme Bertherat
    Affiliations
    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
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  • Christophe Baillard
    Affiliations
    Universite de Paris, Sorbonne Paris Cite, France

    Department of Anesthesiology, Cochin Hospital, APHP, Paris, France
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  • Gilles Manceau
    Affiliations
    Universite de Paris, Sorbonne Paris Cite, France

    Department of Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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  • Louis Puybasset
    Affiliations
    Sorbonne University, Paris, France

    Department of Anesthesiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
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  • Jacques Blacher
    Affiliations
    Universite de Paris, Sorbonne Paris Cite, France

    Department of Hypertension and Cardiovascular Prevention, Hotel Dieu Hospital, AP-HP, Paris, France
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  • Bernard Cholley
    Affiliations
    Universite de Paris, Sorbonne Paris Cite, France

    Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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  • Anne-Paule Gimenez-Roqueplo
    Affiliations
    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
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  • Bertrand Dousset
    Affiliations
    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
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  • Laurence Amar
    Affiliations
    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
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  • Fabrice Menegaux
    Affiliations
    Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France

    Sorbonne University, Paris, France
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  • Sébastien Gaujoux
    Correspondence
    Reprint requests: Sébastien Gaujoux, MD, PhD, Department of Pancreatic, General, Visceral, and Endocrine Surgery, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, 47-83 Avenue de l’Hôpital, 75013 Paris, France.
    Affiliations
    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
    Search for articles by this author

      Abstract

      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.
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