Prolonged Postoperative Vasoplegia in Pediatric Patients on Chronic Angiotensin II Blocker Treatment

Abstract

Prolonged postoperative vasoplegia is known to occur following cardiac surgery in patients on chronic angiotensin II receptor blocker (ARB) treatment in adults. The perioperative management of these drugs in the pediatric population is not well described and here we would like to highlight this fact. While ARBs are increasingly used in children and adolescents with hypertension, there is lack of data to guide optimal pre-surgical management in the pediatric age group. We report two cases of prolonged vasoplegia following cardiopulmonary bypass occurring in adolescent patients on chronic ARB therapy and the importance of cessation of these drugs preoperatively.

Clinical approach to vasoplegia in the transplant patient from the Pediatric Heart Transplant Society

“…Table 1 details pre‐transplant risk factors associated with vasoplegia 1–11 . The majority of these factors are considered to be precursors or triggers of a proinflammatory state, endothelial dysfunction or enhancement of circulating hormones that lead to refractory vasodilation 12–15 .…”

“…Table 1 details pre-transplant risk factors associated with vasoplegia. [1][2][3][4][5][6][7][8][9][10][11] The majority of these factors are considered to be precursors or triggers of a proinflammatory state, endothelial dysfunction or enhancement of circulating hormones that lead to refractory vasodilation. [12][13][14][15] This pathologic decline in systemic vascular resistance is typically seen within the first 24 h following transplant and will often improve within the next 2-3 days.…”

“…): • Hypovolemia or significant bleeding • Sepsis or significant infection • Significant systolic heart dysfunction (e.g., primary graft dysfunction) • Right heart failure (especially in setting of elevated pulmonary vascular resistance index [PVRi])• Anaphylaxis TA B L E 1 Patients potentially at increased risk for vasoplegia post-transplant[1][2][3][4][5][6][7][8][9][10][11] …”