Journal of cardiothoracic and vascular anesthesia · 2026
Vasoplegic Syndrome during Left Ventricular Assist Device Insertion: A Systematic Review and Meta-Analysis.
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Kumar Nicolas, Ortoleva Jamel P, Fitzsimons Michael G, Dalia Adam A, Michel Eriberto, Sawyer Tamara R, Bardia Amit
Аннотация
OBJECTIVES: To determine the incidence of vasoplegic syndrome (VS) following durable left ventricular assist device (LVAD) insertion and to identify associated risk factors and clinical outcomes.
DESIGN: Systematic review and meta-analysis conducted per PRISMA guidelines, with risk of bias assessed using the Newcastle-Ottawa Scale. Meta-analysis calculated relative risks (RR), odds ratios (OR), and weighted mean differences (WMD).
SETTING: Systematic search of MEDLINE and EMBASE from inception to May 1, 2026.
PARTICIPANTS: Adults undergoing durable LVAD insertion across 16 retrospective studies, encompassing 3,121 LVAD insertions with 1,093 identified VS cases.
INTERVENTIONS: Durable LVAD insertion via cardiopulmonary bypass (CPB).
MEASUREMENTS AND MAIN RESULTS: The pooled VS incidence was 36.30% (95% CI: 34.61%-38.02%). Risk factors included male sex (RR 1.65, p = 0.008), INTERMACS profile ≤2 (RR 1.19, p = 0.009), repeat sternotomy (RR 1.30, p = 0.020), concomitant procedures (RR 1.27, p = 0.003), and longer CPB duration (WMD 13.17 minutes, p < 0.001). VS was associated with increased right ventricular failure (OR 1.76, p < 0.001), renal replacement therapy (OR 1.77, p < 0.001), reoperation for bleeding (OR 2.46, p < 0.001), and prolonged ICU stay (10.00 v 6.34 days, p < 0.001). Mortality was significantly higher in patients with VS at both 30 days (14.85% v 5.63%, p < 0.001) and 1 year (33.88% v 22.62%, p = 0.030).
CONCLUSION: VS affects approximately one-third of LVAD recipients and is associated with substantially increased postoperative morbidity and mortality. The identified risk factors support preoperative risk stratification and the development of targeted intervention strategies.
DESIGN: Systematic review and meta-analysis conducted per PRISMA guidelines, with risk of bias assessed using the Newcastle-Ottawa Scale. Meta-analysis calculated relative risks (RR), odds ratios (OR), and weighted mean differences (WMD).
SETTING: Systematic search of MEDLINE and EMBASE from inception to May 1, 2026.
PARTICIPANTS: Adults undergoing durable LVAD insertion across 16 retrospective studies, encompassing 3,121 LVAD insertions with 1,093 identified VS cases.
INTERVENTIONS: Durable LVAD insertion via cardiopulmonary bypass (CPB).
MEASUREMENTS AND MAIN RESULTS: The pooled VS incidence was 36.30% (95% CI: 34.61%-38.02%). Risk factors included male sex (RR 1.65, p = 0.008), INTERMACS profile ≤2 (RR 1.19, p = 0.009), repeat sternotomy (RR 1.30, p = 0.020), concomitant procedures (RR 1.27, p = 0.003), and longer CPB duration (WMD 13.17 minutes, p < 0.001). VS was associated with increased right ventricular failure (OR 1.76, p < 0.001), renal replacement therapy (OR 1.77, p < 0.001), reoperation for bleeding (OR 2.46, p < 0.001), and prolonged ICU stay (10.00 v 6.34 days, p < 0.001). Mortality was significantly higher in patients with VS at both 30 days (14.85% v 5.63%, p < 0.001) and 1 year (33.88% v 22.62%, p = 0.030).
CONCLUSION: VS affects approximately one-third of LVAD recipients and is associated with substantially increased postoperative morbidity and mortality. The identified risk factors support preoperative risk stratification and the development of targeted intervention strategies.