Journal of cardiothoracic and vascular anesthesia · 2025
Outcomes and Risk Factors in Vasoplegic Patients Following Left Ventricular Assist Device Implantation.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Emery Darrick A, Ciapala Stephanie, Williams J Bradley, Bhattacharya Sanjeeb, Higgins Andrew, Lee Ran, Bhat Pavan, Soltesz Edward, Tong Michael Z, Hohlfelder Benjamin
Аннотация
OBJECTIVE: To describe vasoplegia incidence, management strategies, and factors associated with vasoplegia in a HeartMate left ventricular assist device (LVAD) patient population.
DESIGN: A retrospective, observational study was performed. The primary outcome was the incidence of vasoplegia (persistent hypotension requiring >0.2 μg/kg/min norepinephrine equivalent for >6 hours) following LVAD implantation. Multivariable logistic regression analysis was conducted to determine factors associated with the development of vasoplegia. A subgroup analysis was performed to compare patients who received and did not receive preoperative renin-angiotensin-aldosterone system inhibitors to evaluate their impact on postoperative vasoplegia.
SETTING: A single-center, quaternary care academic medical center.
PARTICIPANTS: Adult patients (N = 184) who will undergo LVAD implantation from 2019 to 2022.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The incidence of vasoplegia was 33%. In patients who developed vasoplegia, the median maximum dosage of vasopressors was 0.28 μg/kg/min (0.24-0.34) norepinephrine equivalents with a median duration of 30 hours (18-50) on vasopressors. Mean arterial pressure immediately before the operating room (OR 0.961), duration on cardiopulmonary bypass (OR 1.012), preoperative renal dysfunction (OR 3.185), and postoperative inotrope use (OR 4.857) were independently associated with risk of vasoplegia based on multivariable logistic regression analysis. No differences in rates of vasoplegia were observed based on receipt of preoperative renin-angiotensin-aldosterone system inhibitors. No mortality differences were observed between patients who did versus did not develop vasoplegia.
CONCLUSIONS: Vasoplegia following LVAD implantation is a common postoperative complication. Longer duration on cardiopulmonary bypass, preoperative renal dysfunction, and postoperative inotrope use following LVAD implantation were associated with an increased risk of developing postoperative vasoplegia.
DESIGN: A retrospective, observational study was performed. The primary outcome was the incidence of vasoplegia (persistent hypotension requiring >0.2 μg/kg/min norepinephrine equivalent for >6 hours) following LVAD implantation. Multivariable logistic regression analysis was conducted to determine factors associated with the development of vasoplegia. A subgroup analysis was performed to compare patients who received and did not receive preoperative renin-angiotensin-aldosterone system inhibitors to evaluate their impact on postoperative vasoplegia.
SETTING: A single-center, quaternary care academic medical center.
PARTICIPANTS: Adult patients (N = 184) who will undergo LVAD implantation from 2019 to 2022.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The incidence of vasoplegia was 33%. In patients who developed vasoplegia, the median maximum dosage of vasopressors was 0.28 μg/kg/min (0.24-0.34) norepinephrine equivalents with a median duration of 30 hours (18-50) on vasopressors. Mean arterial pressure immediately before the operating room (OR 0.961), duration on cardiopulmonary bypass (OR 1.012), preoperative renal dysfunction (OR 3.185), and postoperative inotrope use (OR 4.857) were independently associated with risk of vasoplegia based on multivariable logistic regression analysis. No differences in rates of vasoplegia were observed based on receipt of preoperative renin-angiotensin-aldosterone system inhibitors. No mortality differences were observed between patients who did versus did not develop vasoplegia.
CONCLUSIONS: Vasoplegia following LVAD implantation is a common postoperative complication. Longer duration on cardiopulmonary bypass, preoperative renal dysfunction, and postoperative inotrope use following LVAD implantation were associated with an increased risk of developing postoperative vasoplegia.