Taner, Cemal Burcin

AbstractIntroductionTakotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy or stress‐induced cardiomyopathy, has been described following a variety of surgeries and disease states. The relationship between intra‐operative anesthesia management and the development of this syndrome has never been fully elucidated.ObjectivesThe primary objective of this study was to determine the relationship of multiple intra‐operative factors on the pathogenesis of TTS.MethodsA single‐center retrospective review of all liver transplants performed at Mayo Clinic Florida from January 2005 to December 2014. Patients developing left ventricular dilation and a concomitant decrease in ejection fraction, a negative cardiac catheterization, or stress test within 30 days of transplantation were identified. Cases were matched 2:1 to controls with respect to MELD, age, sex, and indication for transplantation. Our evaluation included liver graft characteristics, intra‐operative medications, and intra‐operative hemodynamic measurements.ResultsWe identified 24 cases of TTS from a pool of 1752 transplants, for an incidence of 1.4%. No statistically significant differences in intra‐operative measures between the two groups were identified (all P ≥ .08).ConclusionOur exploratory, single‐center retrospective review evaluating 46 intra‐operative characteristics found no association with the development of TTS.

AbstractAimPatent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of aPFOin patients undergoing liver transplantation (LT) is unknown.ObjectiveAssess the impact ofPFOand physiologic intrapulmonary shunt (IPS) on the perioperative outcomes of patients who underwentLT.MethodsWe performed a retrospective, intention‐to‐treat analysis of patients withPFOand controls withoutPFOwho underwentLTat Mayo Clinic in Florida between 2008 and 2013. Patients with physiologicIPSwere also analyzed. The cohorts were compared for baseline characteristics, length of stay in the intensive care unit (ICU), postoperative oxygen requirements, 30‐d cerebrovascular accidents, and mortality.ResultsOf the 935 patients who underwentLT, 10.4% had provenPFOby pre‐LTechocardiogram. Control patients (n = 101) were statistically older thanPFOandIPS(n = 56) patients, but similar in sex,BMI, Model for End‐stage Liver Disease score, American Society of Anesthesiologist score, and left ventricular ejection fraction.PFOandIPSpatients had similar length of stay in theICU, mechanical ventilation times, post‐LToxygen requirements, and 30‐d mortality compared to controls. Subgroup analysis showed similar outcomes for largePFOandIPSpatients to controls.ConclusionsThe presence ofPFOdid not have a negative impact on perioperativeLToutcomes.