Vasoplegia Following Orthotopic Heart Transplantation: Prevalence, Predictors and Clinical Outcomes

Batchelor, R.; Wong, Nathan D; Liu, David Hongwei; Chua, Ciersiang; William, J.; Tee, Su Ling; Sata, Yusuke; Bergin, Peter; Hare, James L.; Leet, Angeline; Taylor, Andrew J.; Patel, Hitesh; Burrell, Aidan; McGiffin, David C.; Kaye, D.

doi:10.1016/j.cardfail.2021.11.020

Cited by 20 publications

(15 citation statements)

References 25 publications

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“…Patients underwent routine surveillance for allograft function via endomyocardial biopsy and echocardiography at 1, 2, 3 and 4 weeks, as well as at 3, 6, 9 and 12 months after transplantation. Posttransplantation vasoplegia was defined according to the binary definition of vasoplegia: cardiac index of 2.5 L/min/m2 or greater and the need for noradrenaline (≥5 µg/min), adrenaline (≥4 µg/min) or vasopressin (≥1 unit/h) to maintain a mean arterial blood pressure of 65 mm Hg for 6 consecutive hours during the first 48 h after surgery [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Pállinger

Székely

Töreki

et al. 2023

IJMS

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The proinflammatory cascade that is activated at the time of brain death plays a crucial role in organ procurement. Our aim of this study was to explore the relationship between the clinical outcome of orthotopic heart transplantation, as well as cytokine and apolipoprotein profiles of the pericardial fluid obtained at donation. Interleukin, adipokine and lipoprotein levels in the pericardial fluid, as well as clinical data of twenty donors after brain death, were investigated. Outcome variables included primary graft dysfunction, the need for posttransplantation mechanical cardiac support and International Society for Heart and Lung Transplantation grade ≥ 2R rejection. Hormone management and donor risk scores were also investigated. Lower levels of IL-6 were observed in primary graft dysfunction (median: 36.72 [IQR: 19.47–62.90] versus 183.67 [41.21–452.56]; p = 0.029) and in the need for mechanical cardiac support (44.12 [20.12–85.70] versus 247.13 [38.51–510.38]; p = 0.043). Rejection was associated with lower ApoAII (p = 0.021), ApoB100 (p = 0.032) and ApoM levels (p = 0.025). Lower adipsin levels were detected in those patients receiving desmopressin (p = 0.037); moreover, lower leptin levels were found in those patients receiving glucocorticoid therapy (p = 0.045), and higher T3 levels were found in those patients treated with L-thyroxine (p = 0.047) compared to those patients not receiving these hormone replacement therapies. IL-5 levels were significantly associated with UNOS-D score (p = 0.004), Heart Donor Score (HDS) and Adapted HDS (p < 0.001). The monitoring of immunological and metabolic changes in donors after brain death may help in the prediction of potential complications after heart transplantation, thus potentially optimizing donor heart allocation.

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Section: Methodsmentioning

confidence: 99%

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Pállinger

Székely

Töreki

et al. 2023

IJMS

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“…Age, history of thyroid disease or chronic kidney disease, ventricular-assist device before transplant, duration of cardiopulmonary bypass, and intraoperative blood products are associated with this condition. 8,11,12 Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is associated with vasoplegia after cardiac surgery, 13 although this is less well-documented after heart transplantation. 8 Nevertheless, the presence of a vasoplegic syndrome may be associated with an unfavorable prognosis in heart transplantation patients, 14 and the consequences of the vasoplegia do not appear to differ after heart transplantation and after standard cardiac surgery.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Defining Vasoplegia A refractory vasoplegic syndrome (a persistent low vascular resistance requiring intravenous vasopressors) is observed in 11 to 60% of heart transplantation patients. 7,8 There is currently no standard consensus on the definition of vasoplegic syndrome after cardiac surgery or more specifically after heart transplantation, but hypotension occurring within 24 h of heart transplantation with a cardiac index greater than 2.2 l/kg/m 2 and a systemic vascular resistance of less than 800 dyne.s/cm 5 is generally considered characteristic of this situation. 7,9 The pathophysiology of vasoplegic syndrome remains poorly understood, but it could be associated with cytokine release, adrenergic receptor desensitization, increased nitric oxide synthesis, relative deficiency of vasopressin, activation of adenosine triphosphate-sensitive potassium channels, vascular smooth muscle cell membrane hyperpolarization, dysfunction of the renin-angiotensin system, and endothelial glycocalyx alteration.…”

Section: Hemodynamic Management Vasoplegiamentioning

confidence: 99%

Perioperative Management of Heart Transplantation: A Clinical Review

Nesseler¹,

Mansour²,

Cholley

et al. 2023

Anesthesiology

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This article has been selected for the Anesthesiology CME Program (www.asahq.org/JCME2023OCT). Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal's Web site (www.anesthesiology.org).

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“…VS is reported to occur in up to 20 to 63% of patients, 2,3 and may be related to longer CBP duration 4 . Current therapy includes the administration of volume and vasopressors, which in turn are associated with increased mortality and morbidity 1,3,5 . Further possibilities of drug therapy are methylene blue and vasopressin 6,7 .…”

mentioning

confidence: 99%

“…The pathogenesis is considered to be multifactorial. Contact activation, adenine triphosphate [ATP] deficiency, activation of the complement and coagulation systems as well as various anesthetics and their effects on vascular tone are discussed 1,3,5,8 .…”

mentioning

confidence: 99%

Vasoplegic syndrome in cardiovascular surgery; evaluating effects of Sevoflurane and Glibenclamide in a porcine model

Winter

Nepper

Hermann

et al. 2023

Preprint

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Background: Vasoplegic syndrome is frequently observed during cardiac surgery and resembles a complication of high mortality and morbidity. There is a clinical need for therapy and prevention of vasoplegic syndrome during complex cardiac surgical procedures. Therefore, we investigated different strategies in a porcine model of vasoplegia. Methods: We evaluated new medical therapies and prophylaxis to avoid vasoplegic syndrome in a porcine model. After induction of anesthesia, cardiopulmonary bypass was established through median sternotomy and central cannulation. Prolonged aortic cross-clamping (120 min) simulated a complex surgical procedure. The influence of sevoflurane-guided anesthesia (sevoflurane group) and the administration of glibenclamide (glibenclamide group) were compared to a control group, which received standard anesthesia using propofol. Online hemodynamic assessment was performed using PiCCO® measurements. In addition, blood and tissue samples were taken to evaluate hemodynamic effects and the degree of inflammatory response. Results: Glibenclamide was able to break through early vasoplegic syndrome by raising the blood pressure and systemic vascular resistance as well as less need of norepinephrine doses. Sevoflurane reduced the occurrence of the vasoplegic syndrome in the mean of stable blood pressure and less need of norepinephrine doses. Conclusion: Glibenclamide could serve as a potent drug to reduce effects of vasoplegic syndrome. Sevoflurane anesthesia during cardiopulmonary bypass shows less occurrence of vasoplegic syndrome and therefore could be used to prevent it in high-risk patients.

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Vasoplegia Following Orthotopic Heart Transplantation: Prevalence, Predictors and Clinical Outcomes

Cited by 20 publications

References 25 publications

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Perioperative Management of Heart Transplantation: A Clinical Review

Vasoplegic syndrome in cardiovascular surgery; evaluating effects of Sevoflurane and Glibenclamide in a porcine model

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