Abstract 14873: Takotsubo Syndrome and Surgery: A Systematic Review

Abstract

Background: Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction. An increasing number of studies have shown surgery as a trigger for TTS. Methods: We performed a systematic review of all case reports and case series reporting an association between surgery and TTS by searching PubMed, EMBASE, and Cochrane Library databases in June 2022. A total of 172 cases (Surgery-TTS) were selected and compared with previously reported 1,750 TTS patients of any type (All-TTS). Results: In TTS patients triggered by surgery, the most common symptom was dyspnea (48.6%), followed by chest pain (31.8%) and dizziness (4.7%). The most common type of TTS was apical, accounting for 80.4% of cases, followed by the basal (8.2%), biventricular (5.1%), and midventricular (3.8%) types. Among these cases, 46.5% were associated with intraabdominal procedures, 25% with cardiothoracic surgery, followed by 12.3% with ENT/Ophthalmology and 8.7% with neurosurgery. Compared with the All-TTS cohort, the Surgery-TTS cohort was younger (55.9 vs 66.4, P < 0.001) and had a lower incidence of chest pain (75.9% vs. 31.8%; P < 0.001) and QT prolongation (18.0% vs. 47.7%, P < 0.001) but a significantly increased in-hospital mortality (10.4% vs 4.1%, P = 0.001). Furthermore, basal-type TTS was significantly more common in the Surgery-TTS cohort than in the All-TTS cohort (8.2% vs. 2.2%, P < 0.001). Conclusions: Surgical triggers are associated with increased mortality and atypical presentation in TTS patients when compared with patients who have TTS of all types. A high degree of clinical suspicion is required to concurrently diagnose TTS in surgical patients.