Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation

Chan, Joshua L.; Kobashigawa, Jon A.; Aintablian, T.; Dimbil, S.; Perry, Paul A.; Patel, Jignesh; Kittleson, M.; Czer, L.; Zarrini, Parham; Velleca, A.; Rush, Jenna; Arabía, Francisco A.; Trento, Alfredo; Esmailian, F.

doi:10.1016/j.athoracsur.2017.09.039

Cited by 42 publications

(39 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, we observed higher rates of major bleeding episodes among vasoplegic patients. This confirms the work of Chan and colleagues, who found a similar trend among transplant recipients, and Patarroyo with blood transfusions . Although this finding may identify an area of confounding, the majority of bleeding events after LVAD implantation resolve within 24 hours.…”

Section: Discussionsupporting

confidence: 89%

“…This confirms the work of Chan and colleagues, who found a similar trend among transplant recipients, and Patarroyo with blood transfusions. 20,21 Although this finding may identify an area of confounding, the majority of bleeding events after LVAD implantation resolve within 24 hours. In our experience, 73% of the bleeding events resolved within 24 hours.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…As such, flow and hematocrit are optimized to maintain end‐organ perfusion, and anesthetic depth is optimally maintained with agents chosen to minimize effects on SVR. Low mean arterial pressure and worsening signs of end‐organ hypoperfusion (eg, lactic acidosis) despite adequate CPB flow and vasopressor support are the hallmarks of vasoplegia: a syndrome cited to affect between 16% and 34% of patients during or after HT . Although vasoplegia can exist in isolation, it often occurs simultaneously with severe PGF.…”

Section: Perioperative Eventsmentioning

confidence: 99%

“…Although vasoplegia can exist in isolation, it often occurs simultaneously with severe PGF. HT recipients who develop vasoplegia are more likely to be male patients, have elevated BMI, elevated pre‐transplant creatinine, and to have concomitant LVAD explant . Vasoplegia in these patients is associated with significant 30 and 60 day mortality .…”

Section: Perioperative Eventsmentioning

confidence: 99%

Management of primary graft failure after heart transplantation: Preoperative risks, perioperative events, and postoperative decisions

Truby

DeRoo

Spellman

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

Primary graft failure (PGF) after heart transplantation (HT) is a devastating and unexpected event characterized by failure of the graft to adequately support recipient circulation necessitating high doses of vasopressors and inotropes and/or temporary mechanical circulatory support. Although it represents an increasingly common event in the current era, there remains a high degree of variability in prevalence, reported risk factors, and approach to this clinical entity. The purpose of the current review is to highlight preoperative considerations including known incidence and risk factors, perioperative issues involving the identification and management of PGF, and postoperative decisions related to weaning of mechanical circulatory support and titration of immunosuppressive therapy. Lastly, we highlight future directions in PGF research, involving basic and translational research, that have the potential to uncover novel strategies of risk stratification and treatment.Case: Our patient is a 53-year-old man with end-stage non-ischemic dilated cardiomyopathy complicated by ventricular tachycardia (VT), post-capillary pulmonary hypertension, and renal insufficiency. After progressing to NYHA Class IV symptoms, he underwent implantation of a durable left ventricular assist device (LVAD) as bridge to transplant (BTT). On device support, he developed recurrent VT resulting in multiple defibrillator discharges and hospital admission for intravenous anti-arrhythmic therapy. He is subsequently upgraded to a higher status on the waiting list. A suitable donor is identified, with an appropriate predicted heart mass and an anticipated ischemic time of <4 hours. He is taken to the operating room, where at the time of anesthesia induction he develops vasodilatory shock, requiring high-dose vasopressors, and cardiopulmonary bypass (CPB) support for dissection. After surgical anastomosis, cross clamp removal and reperfusion, graft function is extremely poor, there is significant bradycardia requiring pacing, and the patient is unable to be weaned successfully from CPB. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is initiated, and the patient is transferred to the intensive care unit. Retrospective flow crossmatch is negative. This patient is suffering from severe primary graft failure. K E Y W O R D Sgraft survival, heart (allograft) function/dysfunction, heart failure/injury

show abstract

“…Chan and colleagues [1] describe the incidence, risk factors, and outcomes of postoperative vasoplegia in a cohort of patients undergoing orthotopic heart transplantation. In a retrospective review of 244 patients over a 3-year period, these investigators concluded that longer cardiopulmonary bypass times and higher preoperative creatinine were associated with the development of vasoplegia after the operation.…”

Section: Invited Commentarymentioning

confidence: 99%

Invited Commentary

Clarizia

Ruel

2018

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation

Cited by 42 publications

References 25 publications

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Management of primary graft failure after heart transplantation: Preoperative risks, perioperative events, and postoperative decisions

Invited Commentary

Contact Info

Product

Resources

About