Vasoplegia After Left Ventricular Assist Device Implantation: A Meta-analysis of Incidence, Predictors, and Clinical Outcomes.

OBJECTIVES

To characterize the incidence, predictors, and clinical outcomes of vasoplegia following left ventricular assist device (LVAD) implantation.

DESIGN

Systematic review and study-level meta-analysis.

SETTING

Tertiary care.

PARTICIPANTS

Patients receiving a continuous-flow LVAD.

INTERVENTIONS: No interventions were performed.

MEASUREMENTS AND MAIN

RESULTS

Medline, Embase, and the Cochrane Library were searched from inception to March 2026 for studies on continuous-flow LVADs reporting vasoplegia as an outcome. The incidence of vasoplegia was estimated as a pooled proportion. Comparative analysis was performed using random-effects meta-analysis by pooling risk ratios with 95% confidence intervals for binary endpoints or mean differences, if continuous. Long-term survival was evaluated using Kaplan-Meier-derived time-to-event data with a Cox frailty model to obtain hazard ratios. Risk factors from multivariable regression models were pooled to identify predictors. A 2-tailed p < 0.05 was considered statistically significant. RStudio was used for all analyses. Nine observational studies (n = 1,855) were included. Vasoplegia developed in 34.2% of patients (95% confidence interval, 26.9%-42.4%) and was associated with higher early mortality and major bleeding, as well as worse long-term survival and longer hospital stays. No difference was found in intensive care unit mortality, acute kidney injury, stroke, and right heart failure. Male sex and higher body mass index were identified as risk factors for vasoplegia, while higher blood pressure was protective. Renin-angiotensin-aldosterone inhibitors, β-blockers, neutrophil/lymphocyte ratio, Interagency Registry for Mechanically Assisted Circulatory Support classes I to II, cardiopulmonary bypass time, serum creatinine, diabetes, and ischemic cardiomyopathy were not significant predictors.

CONCLUSIONS

Vasoplegia affects approximately one-third of patients following LVAD implantation and is associated with worse postoperative outcomes.