Cardiopulmonary Bypass Increases the Risk of Vasoplegic Syndrome After Coronary Artery Bypass Grafting in Patients With Dialysis-Dependent Chronic Renal Failure

Hossne, Nelson Américo; Miranda, Matheus; Monteiro, Marcus Rodrigo; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Pestana, José Osmar Medina; Gomes, Walter J.

doi:10.5935/1678-9741.20140092

Cited by 12 publications

(16 citation statements)

References 24 publications

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“…The use of CPB in cardiac surgery has been frequently linked with vasoplegia, with the rate of vasoplegia being higher for patients who have CPB than for those who have offpump coronary artery bypass surgery. 9 Our study also reflected this inflammatory cascade, with worsening vasoplegia as CPB duration increased. The rates of concomitant procedures also increased across the vasoplegia severities, which may partly explain the increased CPB durations.…”

Section: Discussionsupporting

confidence: 64%

“…7 Another study reported a mortality rate of 50% for dialysis-dependent patients who underwent CPB and subsequently developed vasoplegia. 9 Our work reiterated the association between vasoplegia and mortality, as patients with moderate to severe vasoplegia had a >2-fold increase in risk of mortality. In addition, we observed higher rates of major bleeding episodes among vasoplegic patients.…”

Section: Discussionmentioning

confidence: 63%

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Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

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BackgroundVasoplegia is associated with adverse outcomes following cardiac surgery; however, its impact following left ventricular assist device implantation is largely unexplored.Methods and ResultsIn 252 consecutive patients receiving a left ventricular assist device, vasoplegia was defined as the occurrence of normal cardiac function and index but with the need for intravenous vasopressors within 48 hours following surgery for >24 hours to maintain a mean arterial pressure >70 mm Hg. We further categorized vasoplegia as none; mild, requiring 1 vasopressor (vasopressin, norepinephrine, or high‐dose epinephrine [>5 μg/min]); or moderate to severe, requiring ≥2 vasopressors. Predictors of vasoplegia severity were determined using a cumulative logit (ordinal logistic regression) model, and 1‐year mortality was evaluated using competing‐risks survival analysis. In total, 67 (26.6%) patients developed mild vasoplegia and 57 (22.6%) developed moderate to severe vasoplegia. The multivariable model for vasoplegia severity utilized preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time, which yielded an area under the curve of 0.76. Although no significant differences were noted in stroke or pump thrombosis rates (P=0.87 and P=0.66, respectively), respiratory failure and major bleeding increased with vasoplegia severity (P<0.01). Those with moderate to severe vasoplegia had a significantly higher risk of mortality than those without vasoplegia (adjusted hazard ratio: 2.12; 95% confidence interval, 1.08–4.18; P=0.03).ConclusionsVasoplegia is predictive of unfavorable outcomes, including mortality. Risk factors for future research include preoperative INTERMACS profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 63%

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

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“…Evidências mostram que a diminuição da resposta inflamatória na CRM sem CEC leva a uma redução de disfunção orgânica, 2 assim como menores índices de vasoplegia e lesão renal. 12 Neste cenário, análises retrospectivas em grandes populações confirmam uma redução significativa da morbimortalidade quando a CRM é realizada sem CEC. 13,14 Assim, mesmo uma análise nos quatro maiores centros dos EUA mostrou benefício quando a CRM foi realizada sem CEC, principalmente nos pacientes considerados de alto risco.…”

Section: Discussionunclassified

Impacto Atual da Circulação Extracorpórea na Cirurgia de Revascularização Miocárdica no Estado de São Paulo

Borgomoni¹,

Mejía²,

Orlandi³

et al. 2020

Arquivos Brasileiros De Cardiologia

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Fundamento: Resultados prévios com o uso de circulação extracorpórea (CEC) geram dificuldades na escolha do melhor tratamento para cada paciente na cirurgia de revascularização miocárdica (CRM) no contexto atual. Objetivo: Avaliar o impacto da CEC no cenário atual da CRM no estado de São Paulo. Métodos: Foram analisados 2.905 pacientes submetidos à CRM de forma consecutiva em 11 centros do estado de São Paulo pertencentes ao Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) I. Dados perioperatórios e de seguimento foram colocados via on-line por especialistas treinados e capacitados em cada hospital. Foram analisadas as associações das variáveis perioperatórias com o tipo de procedimento (com ou sem CEC) e com os desfechos. A mortalidade esperada foi calculada por meio do EuroSCORE II (ESII). Os valores de p menores de 5% foram considerados significativos. Resultados: Não houve diferença significativa em relação à idade dos pacientes entre os grupos (p=0,081). Dentre os pacientes, 72,9% eram de sexo masculino; 542 pacientes foram operados sem CEC (18,7%). Das características préoperatórias, pacientes com infarto agudo do miocárdio (IAM) prévio (p=0,005) e disfunção ventricular (p=0,031) foram operados com CEC; no entanto, pacientes de emergência ou em classe funcional New York Heart Association (NYHA) IV foram operados sem CEC (p<0,001). O valor do ESII foi semelhante para ambos os grupos (p=0,427). Na CRM sem CEC, houve preferência pelo uso do enxerto radial (p<0,001) e com CEC pela artéria mamária direita (p<0,001). No pós-operatório, o uso de CEC esteve associado com reoperação por sangramento (p=0,012).

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“…22 Vasoplegia can occur during CPB because of the activation of nitric oxide synthase, smooth muscle K+ channels, and relatively reduced vasopressin levels. 23 It results in systemic vasodilation and hypotension that is resistant to conventional therapy. Methylene blue, a competitive inhibitor of nitric oxide, can be used as a rescue drug.…”

Section: Mechanical Complications Of Cardiopulmonary Bypassmentioning

confidence: 99%

“…Methylene blue, a competitive inhibitor of nitric oxide, can be used as a rescue drug. 23 Hemolysis occurs in all extra-corporeal circuits due to shear stress, wall impact forces, contact with non-endothelial surfaces, positive and negative pressures. A high degree of hemolysis that goes beyond the endogenous clearing mechanisms can lead to the accumulation of plasma-free Hb.…”

Section: Mechanical Complications Of Cardiopulmonary Bypassmentioning

confidence: 99%

Complications of Coronary Artery Bypass Grafting

Hussain

Harky

2019

Int J Med Rev

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Introduction Coronary artery bypass grafting (CABG) is one of the most commonly performed operations with approximately 200 000 procedures performed annually in the United States of America and an incidence of 62 per 200 000 inhabitants in Western Europe. 1 It has evolved over the past century from a high-risk procedure to a relatively safe one with a current mortality rate of 1%-2% in elective patients. 2 Nonetheless, it is still a highly complex surgery and has been associated with a number of complications. The complications from this major surgery can be classified in various ways; some are catastrophic, such as death and stroke, while others can be self-limiting without any long-term residual effects, such as atelectasis, lower respiratory infection, or transient acute kidney injury. 2,3 CABG can be considered as a large operation incorporating many smaller operations. There may be variations in these smaller operations that can have both advantages and disadvantages. However, the end goal is to bypass a blocked or narrow coronary artery by anastomosis of a vessel conduit. 3 This may be done with or without cardio-pulmonary bypass, with arterial or venous grafts, and with open or endoscopic harvesting of conduits. The overall risk of this operation is determined by the Euroscore, which is a statistical determination of risk using logistic regression. 4,5 It is determined by patient-related factors (age, gender, renal impairment, peripheral vascular disease, mobility, previous cardiac surgery, chronic lung disease, active endocarditis, critical pre-operative state, insulin dependent diabetes), cardiac-related factors (NYHA dyspnea classification, CCS angina classification, left ventricular function, recent myocardial infarction, and pulmonary hypertension) and operation factors (urgency, weight of intervention, and involvement of thoracic aorta). 5 For the purposes of valid patient consent, it is considered mandatory to discuss the risk of death, peri-operative myocardial infarction, stroke, and sternal wound infection. 6 The general complications of CABG surgery are briefly discussed below followed by a discussion of the specific complications associated with cardiopulmonary bypass and graft patency. Extent of Complications Complications can be broadly divided into catastrophic events, such as death and stroke, or less serious complications, such as pulmonary, renal, or sternal wound complications. Death Mortality following CABG is reported to be between 1%-2% for elective procedures; however, it can be confounded by many factors including the urgency of the case, previous acute myocardial events, the presence of multiple comorbidities such as diabetes or chronic renal failure, or poor coronary vessels that are not amenable for grafting. 4-6 Stroke Post-operative stroke has an incidence of 1.4% to 3.8%. 2 The risk factors for this complication include increased age,

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Cardiopulmonary Bypass Increases the Risk of Vasoplegic Syndrome After Coronary Artery Bypass Grafting in Patients With Dialysis-Dependent Chronic Renal Failure

Cited by 12 publications

References 24 publications

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Impacto Atual da Circulação Extracorpórea na Cirurgia de Revascularização Miocárdica no Estado de São Paulo

Complications of Coronary Artery Bypass Grafting

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