Pre-operative risk factors and clinical outcomes associated with vasoplegia in recipients of orthotopic heart transplantation in the contemporary era

Patarroyo, Maria; Simbaqueba, Cesar A.; Shrestha, Kevin; Starling, Randall C.; Smedira, Nicholas; Tang, W.H. Wilson; Taylor, David O.

doi:10.1016/j.healun.2011.10.010

Cited by 103 publications

(94 citation statements)

References 16 publications

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“…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%

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

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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.

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Section: Discussionsupporting

confidence: 89%

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

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“…22 We defined patients to have persistent vasoplegia when their vasopressor use could not be weaned within 2 weeks without the initiation of octreotide, midodrine, and/or methylene blue.…”

Section: Definitionsmentioning

confidence: 99%

“…Post-operatively six patients were extubated at a median of 3 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and the other three required tracheostomy at a median of 17 days (14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Post-operatively six patients were extubated at a median of 3 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and the other three required tracheostomy at a median of 17 days (14)(15)…”

Section: Peri-operativementioning

confidence: 99%

Short‐term outcomes of en bloc combined heart and liver transplantation in the failing Fontan

Vaikunth

Concepción

Daugherty

et al. 2019

Clinical Transplantation

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Patients with failing Fontan physiology and liver cirrhosis are being considered for combined heart and liver transplantation. We performed a retrospective review of our experience with en bloc combined heart and liver transplantation in Fontan patients > 10 years old from 2006 to 18 per Institutional Review Board approval. Six females and 3 males (median age 20.7, range 14.2-41.3 years) underwent en bloc combined heart and liver transplantation. Indications for heart transplant included ventricular dysfunction, atrioventricular valve regurgitation, arrhythmia, and/or lymphatic abnormalities. Indication for liver transplant included portal hypertension and cirrhosis. Median Fontan/single ventricular end-diastolic pressure was 18/12 mm Hg, respectively. Median Model for End-Stage Liver Disease excluding International Normalized Ratio score was 10 (7-26), eight patients had a varices, ascites, splenomegaly, thrombocytopenia score of ≥ 2, and all patients had cirrhosis. Median cardiopulmonary bypass and donor ischemic times were 262 (178-307) and 287 (227-396) minutes, respectively. Median intensive care and hospital stay were 19 (5-96) and 29(13-197) days, respectively. Survival was 100%, and rejection was 0% at 30 days and 1 year post-transplant. En bloc combined heart and liver transplantation is an acceptable treatment in the failing Fontan patient with liver cirrhosis.

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“…More recently, the importance of recipient determinants has been emphasised [11•]. Activation of systemic inflammatory response syndrome (SIRS) and development of vasoplegic syndrome in the recipient have also been identified as potential contributors to the development of PGD [19].…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

“…Avoidance of risk factors such as prolonged ischaemia and cardiopulmonary bypass times for SIRS and vasoplegia is desirable but not always practicable, particularly in patients who have already undergone one or more complex cardiac operations prior to heart transplant surgery [19]. As yet, there is no proven therapy for the prevention of SIRS and vasoplegia in the setting of cardiopulmonary bypass.…”

Section: Sirs and Vasoplegiamentioning

confidence: 99%

Primary Graft Dysfunction After Heart Transplantation

et al. 2014

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Primary graft dysfunction (PGD) is a lifethreatening complication of heart transplantation that presents as left, right, or biventricular dysfunction occurring within the first 24 hours of transplant surgery for which there is no identifiable secondary cause. Myocardial injury caused by acute catecholamine toxicity and the release of multiple proinflammatory mediators in the donor, followed by ischaemiareperfusion injury sustained during retrieval, have been considered the predominant pathogenetic processes leading to PGD. Donor, recipient, and procedural factors contribute to the development and severity of the clinical syndrome. The changing donor and recipient characteristics over the last two decades, particularly the increasing donor and recipient age, have led to heightened risk of PGD. PGD is graded from mild to severe depending on the extent of circulatory support that is required to maintain haemodynamic stability and vital organ function. While advances in acute mechanical support devices have improved the outlook for patients with PGD, the rate of mortality remains high for those with severe PGD, reaching 40 %. Potential approaches to preventing or minimising the severity of PGD include optimising donor management, donor heart preservation, and donor/recipient matching.

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Pre-operative risk factors and clinical outcomes associated with vasoplegia in recipients of orthotopic heart transplantation in the contemporary era

Cited by 103 publications

References 16 publications

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Short‐term outcomes of en bloc combined heart and liver transplantation in the failing Fontan

Primary Graft Dysfunction After Heart Transplantation

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