Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson, Kristen M.; Lima, Brian; Lee, Andy Y.; Raza, Fayez; Ching, Grace; Lee, Cheng‐Han; Felius, Joost; Baxter, Ronald; Still, Sasha; Collier, Justin; Hall, Shelley; Joseph, Susan

doi:10.1161/jaha.117.008377

Cited by 25 publications

(30 citation statements)

References 29 publications

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“…If vasoplegia is not promptly treated, the resulted tissue malperfusion might lead to end-organ dysfunction and multiple organ failure. Therefore, this post-operative complication significantly increases the risk of morbidity and mortality [152,153]. Moreover, another study identified a maladapted sympathetic response of the skeletal muscle vasculature to exercise that was characterized by sustained vascular constriction [140].…”

Section: Cell and Tissuementioning

confidence: 99%

Cardiac and Vascular α1-Adrenoceptors in Congestive Heart Failure: A Systematic Review

Kaykı-Mutlu

Papazisi

Palmen

et al. 2020

Cells

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As heart failure (HF) is a devastating health problem worldwide, a better understanding and the development of more effective therapeutic approaches are required. HF is characterized by sympathetic system activation which stimulates α- and β-adrenoceptors (ARs). The exposure of the cardiovascular system to the increased locally released and circulating levels of catecholamines leads to a well-described downregulation and desensitization of β-ARs. However, information on the role of α-AR is limited. We have performed a systematic literature review examining the role of both cardiac and vascular α1-ARs in HF using 5 databases for our search. All three α1-AR subtypes (α1A, α1B and α1D) are expressed in human and animal hearts and blood vessels in a tissue-dependent manner. We summarize the changes observed in HF regarding the density, signaling and responses of α1-ARs. Conflicting findings arise from different studies concerning the influence that HF has on α1-AR expression and function; in contrast to β-ARs there is no consistent evidence for down-regulation or desensitization of cardiac or vascular α1-ARs. Whether α1-ARs are a therapeutic target in HF remains a matter of debate.

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Section: Cell and Tissuementioning

confidence: 99%

Cardiac and Vascular α1-Adrenoceptors in Congestive Heart Failure: A Systematic Review

Kaykı-Mutlu

Papazisi

Palmen

et al. 2020

Cells

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“…The addition of concomitant MV surgery may increase the risk of cfLVAD implantation given increased cardiopulmonary bypass time with potential need to perform aortic cross‐clamping in certain settings such as aortic insufficiency. Indeed, it was reported that increased duration of cardiopulmonary bypass during LVAD implant contributes to postoperative vasoplegia 16 . While aortic cross‐clamping may be utilized, concomitant mitral valve intervention can often be performed without cardioplegic arrest thus avoiding ischemic injury to the right heart with excellent outcomes 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, it was reported that increased duration of cardiopulmonary bypass during LVAD implant contributes to postoperative vasoplegia. 16 While aortic cross-clamping may be utilized, concomitant mitral valve intervention can often be performed without cardioplegic arrest thus avoiding ischemic injury to the right heart with excellent outcomes. 17,18 Operative parameters were comparable between those with and without significant residual MR.…”

Section: Operative Features and Postoperative Outcomesmentioning

confidence: 99%

Fate of preoperative moderate mitral regurgitation following left ventricular assist device implantation

Tang

Duggal²,

Haft

et al. 2021

J Card Surg

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Objective We examined for improvements in preoperative moderate mitral regurgitation following continuous‐flow left ventricular assist device (cfLVAD) implantation. Methods From 2006 to 2020, 190 patients with moderate MR underwent cfVLAD implant without concomitant mitral valve (MV) surgery. Cardiac dimensions and contractility, as well as valve function, were assessed with an echocardiogram (echo) pre‐cfLVAD, and at approximately 1 month post‐cfLVAD. Outcomes were determined by retrospective chart review. Results Median echo follow‐up was 0.94 (0.53, 1.38) months. Residual significant moderate or greater MR was present in 30/190 (15.8%) on follow‐up. Patients with significant residual MR had larger preoperative left ventricular internal diameters in diastole (74.4 ± 8.7 vs. 71.1.0 ± 9.1 mm, p = .034). Significant residual MR was associated with higher preoperative mean pulmonary artery pressures (OR = 1.055, p = .035) and pulmonary capillary wedge pressures (OR = 1.060, p = .034). Significant residual MR on echo was not associated with any survival difference (p = .325). The 1, 5, and 10 year survival were 89.9%, 55.2%, and 34.2%, respectively. Conclusions For patients with moderate MR undergoing LVAD implantation, the likelihood of significant residual MR is low and mitral intervention in this population is not recommended. However, select patients with larger preoperative left heart dimensions and pulmonary vascular pressures may be at risk for persistent residual MR.

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“…Persistent hypotension leads to tissue hypoperfusion that might, ultimately, result in end-organ dysfunction. Therefore, vasoplegia is associated with increased perioperative morbidity and mortality [4][5][6]. Despite the fact that this syndrome is common in cardiac surgery patients and despite its poor prognosis, its underlying pathophysiological mechanism has yet to be elucidated and no consensus has been reached for a guided treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia

Papazisi

Palmen

Danser

2020

Cardiovasc Drugs Ther

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Purpose Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population. Methods Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures). Results The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study. Conclusions AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available.

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Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Cited by 25 publications

References 29 publications

Cardiac and Vascular α1-Adrenoceptors in Congestive Heart Failure: A Systematic Review

Cardiac and Vascular α1-Adrenoceptors in Congestive Heart Failure: A Systematic Review

Fate of preoperative moderate mitral regurgitation following left ventricular assist device implantation

The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia

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