Predictors and Clinical Outcomes of Vasoplegia in Patients Bridged to Heart Transplantation With Continuous Flow Left Ventricular Assist Devices

Asleh, Rabea; Alnsasra, Hilmi; Schettle, Sarah; Taher, Riad; Dunlay, Shannon M.; Stulak, John M.; Daly, Richard C.; Behfar, Atta; Pereira, Naveen L.; Clavell, Alfredo L.; Maltais, Simon; Frantz, Robert P.; Edwards, Brooks S.; Kushwaha, Sudhir S.

doi:10.1016/s0735-1097(19)31584-0

Cited by 5 publications

(19 citation statements)

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“…Research shows that the CPB time has a bearing on the postoperative stay in the ICU, time of hospitalization stay and mortality, especially for patients with poor preoperative physical conditions [31,32]. In our study, EPO only curtail the time of mechanical ventilation and stay in the ICU.…”

Section: Limitationmentioning

confidence: 64%

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Lin

Cui

et al. 2020

Med Sci Monit

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Background:Lung injury after cardiopulmonary bypass (CPB) is a serious postoperative complication and can affect the postoperative recovery. The purpose of this study was to explore whether erythropoietin (EPO) has an effect on lung injury caused by CPB. Material/Methods:Sixty patients who received the CPB were randomly divided into a saline group and the EPO group. All the patients received saline or EPO preoperatively, respectively. The ventilation function, including dynamic compliance, peak airway pressure, and plateau pressure, were recorded. The level of tumor necrosis factor (TNF)-a, interleukin (IL)-1b, and IL-10 in serum and arterial blood gas were analyzed. The mechanical ventilation time in the intensive care unit (ICU), the length of time spent in the ICU, the time from operation to discharge, and the total time of hospitalization were recorded. Adverse events in the ICU were monitored and recorded. Results:EPO significantly decreased the level of TNF-a and IL-1b, but increased the level of IL-10 after CPB. EPO significantly improved pulmonary ventilated function and gas exchange function after CPB. EPO significantly shortened the mechanical ventilation time and stay in the ICU. Conclusions:Preoperative EPO injection reduced lung injury and promoted lung function in patients who underwent CPB.The protection effect of EPO may be associated with inhibition of inflammatory response.

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Section: Limitationmentioning

confidence: 64%

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Lin

Cui

et al. 2020

Med Sci Monit

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“…Hypertension was also found to be associated with the use of sirolimus. Vasoplegia is a known phenomenon immediately post-transplant in adults bridged to transplant using a VAD, 12,13 with longer pretransplant time on VAD associated with an increased risk of vasoplegia. 12 In our patient population, VAD use was significantly Additionally, further research has demonstrated no difference in mortality, length of stay, duration of ventilator support, or short-or long-term survival.…”

Section: Discussionmentioning

confidence: 99%

“…Vasoplegia is a known phenomenon immediately post-transplant in adults bridged to transplant using a VAD, 12,13 with longer pretransplant time on VAD associated with an increased risk of vasoplegia. 12 In our patient population, VAD use was significantly Additionally, further research has demonstrated no difference in mortality, length of stay, duration of ventilator support, or short-or long-term survival. 16,17 Approximately 35% of patients who required anti-hypertensive infusions in the ICU required oral anti-hypertensive medications at discharge.…”

Section: Discussionmentioning

confidence: 99%

Anti‐hypertensive treatment in the immediate post‐operative period and 1 year after pediatric heart transplantation

Kerstein

Donovan

Zinn

et al. 2020

Pediatric Transplantation

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Hypertension is a known complication of pediatric heart transplantation. We sought to identify factors associated with anti-hypertensive use in pediatric heart transplant recipients immediately post-transplant and oral anti-hypertensive use at discharge and 1-year post-transplant. Retrospective chart review was conducted of patients ≤18 years who underwent heart transplantation at two major heart transplant centers between August 1, 2009 and December 31, 2017 with ≥1-year follow-up. Exclusion criteria included re-transplant, multi-organ recipients, survival <1 year, and comorbidities associated with hypertension. Anti-hypertensive use was recorded during initial ICU stay, at discharge, and 1-year post-transplant. Univariate and multivariate analyses determined associations of demographic and diagnostic factors and need for anti-hypertensives. There were 188 patients that met inclusion criteria. Anti-hypertensive infusions were required in the ICU post-transplant in 46 patients (24.5%) for a median of 3 days (1-21 days). Oral anti-hypertensives were required in 58 patients (30.9%

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“…Vasoplegia in the post-operative heart transplant patient who has undergone left ventricular assist device (LVAD) explant is relatively common 1,2 and is frequently associated with prolongation of intensive care stay and inferior outcomes. 3 Vasoplegia can be defined as a negative event occurring in the post-operative period characterised by profound hypotension secondary to systemic vasodilation with a low SVR in the context of preserved cardiac function.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, it is refractory to endogenous catecholamines, necessitating the use of high dose vasopressors to manage the failure of physiologic vasoregulatory mechanisms. 4 Risk factors include pre-operative use of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, increasing age, impaired renal function, prolonged cardiopulmonary bypass (CPB) time 1,2 and higher body mass index (BMI). 5 Pre-operative use of mechanical circulatory support has also been identified as an independent risk factor 6 hypothesised to be due to endothelial and neurohormonal dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Vasoplegia in patients following ventricular assist device explant and heart transplantation

et al. 2021

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Background: Vasoplegia has been shown to be associated with increased morbidity and mortality in patients undergoing cardiac surgery. It has been previously stated that low pulsatile states as seen with current left ventricular assist devices (LVADs) may contribute to vasoplegia post LVAD-explant and heart transplant. We sought to examine the literature regarding vasoplegia in the post-operative setting for patients undergoing LVAD explant and heart transplant. Method: A literature review was conducted to firstly define vasoplegia in the setting of LVAD patients, and secondly to better understand the relationship between vasoplegia and LVAD explantation in the postoperative heart transplant patient cohort. A keyword search of ‘vasoplegia’ OR ‘vasoplegic’ AND ‘transplant’ was used. Search engines used were PubMed, Cochrane Library, ClinicalTrials.gov , Ovid, Scopus and grey literature. Results: 17 studies met the selection criteria for review. Three key themes emerged from the literature. Firstly, there is limited consensus regarding the definition of vasoplegia. Secondly, patients with LVADs experienced higher rates of vasoplegia following heart transplant than their counterparts and thirdly, increased cardiopulmonary bypass time was associated with a higher rate of vasoplegia. Conclusion: Vasoplegia is not clearly defined in the literature as it pertains to the LVAD patient cohort. Patients bridged with LVADs appear to have higher rates of vasoplegia, however the aetiology of this is unclear and may be associated with continuous flow physiology or prolonged cardiopulmonary bypass time. A universal definition will aid in risk stratification, early recognition and management.

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Predictors and Clinical Outcomes of Vasoplegia in Patients Bridged to Heart Transplantation With Continuous Flow Left Ventricular Assist Devices

Cited by 5 publications

References 0 publications

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Anti‐hypertensive treatment in the immediate post‐operative period and 1 year after pediatric heart transplantation

Vasoplegia in patients following ventricular assist device explant and heart transplantation

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