Hydroxocobalamin for the treatment of cardiac surgery-associated vasoplegia: a case series

Abstract

These data indicate considerable heterogeneity in patient response to B, potentially dependent on both patient preoperative condition and non-standardized time of administration. B may provide a useful alternative therapy for refractory hypotension and vasoplegia, but controlled clinical trials to assess efficacy are needed.

When the pressure drops: A case of vasoplegia during a structural heart intervention

“…Recently, hydroxocobalamin (vitamin B12a) has been studied in patients with refractory hypotension after CPB . Cobalamins are direct inhibitors and binders of NO and likely functioning as direct inhibitors of NO synthase.…”

“…47 Recently, hydroxocobalamin (vitamin B12a) has been studied in patients with refractory hypotension after CPB. 49,50 Cobalamins are direct inhibitors and binders of NO and likely functioning as direct inhibitors of NO synthase. It is unclear if hydroxocobalamin has any direct effect on atrial natriuretic peptide or adenosine triphosphate sensitive potassium channel activity beyond the NO-mediated portions of their mechanisms.…”

The curious tale of perioperative precision medicine: a story of hydroxocobalamin and cardiac surgery-associated vasoplegia

“…In this issue of the Journal, Shah et al 7 report their experience with hydroxocobalamin (B 12 ) infusion as a potential rescue agent for refractory vasoplegia during or immediately following cardiopulmonary bypass (CPB). They studied 33 patients who underwent cardiac surgery with the aim of identifying a group of patients in whom this treatment could provide some benefit.…”

“…The case series presented by Shah et al 7 illustrates how a combination of patient-and procedure-related characteristics might identify patients at risk for developing cardiac surgery-associated vasoplegia and how such patients could be grouped according to their MAP responses when treated with B 12 therapy. Nevertheless, given that this was a retrospective case series, the authors could not explore whether the four different groups of phenotypes in MAP responses were explained by some genetically driven individual characteristics or molecular signatures of the patients.…”

“…7 illustre comment une combinaison de caractéristiques liées au patient et à la procédure pourrait identifier des patients à risque de développer une vasoplégie associée à la chirurgie cardiaque et comment ces patients peuvent être groupés en fonction de la réponse de leur PAM quand ils recevaient un traitement par B 12 . Néanmoins, considérant qu'il s'agissait d'une série de cas rétrospectifs, les auteurs n'ont pas pu explorer si la réponse de la PAM dans les quatre différents groupes était expliquée par des caractéristiques génétiques individuelles ou si ces patients présentaient des signatures moléculaires.…”