Incidence and Impact of On-Cardiopulmonary Bypass Vasoplegia During Heart Transplantation.

Published

Journal Article

Despite significant advances in the medical management of heart transplant (HT) recipients, perioperative complications, including vasoplegia, remain a significant contributor to morbidity and mortality. This is a retrospective review of patients who received HT at our institution between 2012 and 2015. Mean systemic vascular resistance (SVR) was calculated during the bypass run. Vasoplegia was defined as a mean SVR <800 dynes s/cm despite a high pressor requirement (>1,500 μg neosynephrine bolused). The primary outcome of interest was 30 day post-transplant survival. There were 138 patients included in the current study. A total of 16% (n = 22) patients were identified as having developed on-cardiopulmonary bypass vasoplegia. Vasoplegic patients had a significantly higher body mass index (BMI) (30.1 ± 5.0 vs. 26.5 ± 4.7; p = 0.005) and were more likely to be male (95.5% vs. 66.4%; p = 0.004). Use of continuous-flow left ventricular assist device (CF-LVAD) as bridge-to-transplant (BTT) was prevalent among vasoplegic patients (81.8% vs. 57.8%; p = 0.033). These patients had significantly decreased survival at 30 and 60 days (86.4% vs. 99.1% at 30 days; 77.3% vs. 92.8% at 60 days). Bridge-to-transplant with CF-LVAD was an independent predictor of on-cardiopulmonary bypass (CPB) vasoplegia. On-CPB vasoplegia complicated 16% of HTs in the current study and was associated with increased mortality. Bridge-to-transplant with CF-LVAD was an independent predictor of this phenomenon.

Full Text

Duke Authors

Cited Authors

  • Truby, LK; Takeda, K; Farr, M; Beck, J; Yuzefpolskaya, M; Colombo, PC; Topkara, VK; Mancini, D; Naka, Y; Takayama, H

Published Date

  • January 2018

Published In

Volume / Issue

  • 64 / 1

Start / End Page

  • 43 - 51

PubMed ID

  • 28777136

Pubmed Central ID

  • 28777136

Electronic International Standard Serial Number (EISSN)

  • 1538-943X

International Standard Serial Number (ISSN)

  • 1058-2916

Digital Object Identifier (DOI)

  • 10.1097/mat.0000000000000623

Language

  • eng