Vasoplegia after heart transplantation: outcomes at 1 year†

Abstract

Although vasoplegia syndrome was associated with an increase in perioperative morbidity, including greater mechanical ventilation time and hospital length of stay, no significant differences in survival or allograft rejection at 1 year was demonstrated.

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

“…In another study, ≈48% and 34% of patients undergoing CPB developed vasoplegia immediately and 24 hours following surgery, respectively, based on mean arterial pressure <50 mm Hg and the need for noradrenaline perfusion >0.08 μg/kg per minute . Another study reported a rate of 31% among heart transplant patients, with vasoplegia defined as “global systemic hypotension within 48 hours of heart transplantation with concurrent requirement of vasopressor administration (eg, vasopressin, epinephrine, or norepinephrine infusion of >5 μg/min) for >24 hours to maintain MAP [mean arterial pressure] >70 mm Hg.” Similarly, in the Esmailian heart transplant study, 34% developed vasoplegia (with the majority categorized as mild) . We adopted Chan and colleagues’ definition of vasoplegia and observed a rate of 49%, which was the highest of the studies reviewed and may be explained by the greater severity of illness in LVAD patients compared with heart transplantation patients.…”

“…We compiled data on consecutive patients undergoing LVAD implantation surgery from June 2008 to May 2016 at the Baylor University Medical Center, after receiving approval from Baylor Scott and White Research Institute's institutional review board (with a waived requirement of informed consent). We followed the framework of Chan and colleagues by defining vasoplegia 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 . As in Esmailian and colleagues’ work, 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 .…”

“…We followed the framework of Chan and colleagues by defining vasoplegia 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. 3 As in Esmailian and colleagues' work, we further categorized vasoplegia as none; mild, requiring 1 vasopressor (vasopressin, norepinephrine, or high-dose epinephrine [>5 lg/ min]); or moderate to severe, requiring ≥2 vasopressors. 4 The list of pre-and intraoperative variables examined are in Table 1.…”

Primary graft dysfunction after heart transplantation: a thorn amongst the roses

“…Recipients, especially patients who have been on inotropic support and mechanical devices, have activation of their systemic inflammatory response, which causes intense vasodilation and therefore lowering of the systemic vascular resistance. The net result is a hypotensive state despite adequate filling and a high cardiac output that is refractory to vasopressor support [64]. The exact pathogenesis of this is poorly understood to date, some mechanisms have been postulated.…”

Vasoresponsiveness in patients with heart failure (VASOR): protocol for a prospective observational study

“…This syndrome is characterized by hypotension and the continuous need of vasopressors, despite a normal or high cardiac index. The incidence of vasoplegia ranges from 11 to 31% in patients undergoing heart failure surgery [5][6][7][8][9]. The prognosis of vasoplegia is poor.…”