Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation

Joshua L. Chan, Jon A. Kobashigawa, Tamar L. Aintablian, Sadia J. Dimbil, Paul Perry, Jignesh K. Patel, Michelle M. Kittleson, Lawrence S. Czer, Parham Zarrini, Angela Velleca, Jenna Rush, Francisco A. Arabia, Alfredo Trento, Fardad Esmailian

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Vasoplegia is characterized as a severe vasodilatory shock after cardiac surgery, and can be associated with substantial morbidity. Increased systemic inflammation and endothelial dysfunction, often related to prolonged cardiopulmonary bypass times, anesthesia, or mechanical circulatory support have been shown to be associated with the development of vasoplegia. We sought to identify risk factors and the impact of various degrees of vasoplegia after heart transplantation. Methods: A retrospective review was conducted of 244 consecutive patients who underwent heart transplantation over a 3-year period. Patients were divided into three groups: no vasoplegia, mild vasoplegia (requiring one vasopressor), and moderate/severe vasoplegia (more than two vasopressors). One-year survival, freedom from rejection, and postoperative complication rates were assessed. Risk factors for vasoplegia subgroups were retrospectively identified. Results: Vasoplegia syndrome was observed in 34.3% of patients after heart transplantation (mild, 74.1%; moderate/severe, 25.9%). Cardiopulmonary bypass time was significantly longer and pretransplant creatinine was significantly higher in the moderate/severe vasoplegia group. There was a strong trend toward greater use of mechanical circulatory support among moderate/severe vasoplegia patients compared with mild and no vasoplegia patients. After heart transplantation, 1-year survival, freedom from rejection, and need for hemodialysis were not significantly different between groups. Conclusions: Vasoplegia syndrome is common after heart transplantation. Risk factors for increased severity include longer cardiopulmonary bypass times and elevated preoperative creatinine. Although higher rates of mortality or graft rejection were not detected, vasoplegia was associated with prolonged intubation, greater blood product usage, and lengthened hospital stay. Further studies involving larger cohorts are warranted.

Original languageEnglish (US)
Pages (from-to)770-777
Number of pages8
JournalAnnals of Thoracic Surgery
Volume105
Issue number3
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

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Vasoplegia
Heart Transplantation
Cardiopulmonary Bypass
Creatinine
Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Chan, J. L., Kobashigawa, J. A., Aintablian, T. L., Dimbil, S. J., Perry, P., Patel, J. K., ... Esmailian, F. (2018). Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation. Annals of Thoracic Surgery, 105(3), 770-777. https://doi.org/10.1016/j.athoracsur.2017.09.039

Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation. / Chan, Joshua L.; Kobashigawa, Jon A.; Aintablian, Tamar L.; Dimbil, Sadia J.; Perry, Paul; Patel, Jignesh K.; Kittleson, Michelle M.; Czer, Lawrence S.; Zarrini, Parham; Velleca, Angela; Rush, Jenna; Arabia, Francisco A.; Trento, Alfredo; Esmailian, Fardad.

In: Annals of Thoracic Surgery, Vol. 105, No. 3, 01.03.2018, p. 770-777.

Research output: Contribution to journalArticle

Chan, JL, Kobashigawa, JA, Aintablian, TL, Dimbil, SJ, Perry, P, Patel, JK, Kittleson, MM, Czer, LS, Zarrini, P, Velleca, A, Rush, J, Arabia, FA, Trento, A & Esmailian, F 2018, 'Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation', Annals of Thoracic Surgery, vol. 105, no. 3, pp. 770-777. https://doi.org/10.1016/j.athoracsur.2017.09.039
Chan, Joshua L. ; Kobashigawa, Jon A. ; Aintablian, Tamar L. ; Dimbil, Sadia J. ; Perry, Paul ; Patel, Jignesh K. ; Kittleson, Michelle M. ; Czer, Lawrence S. ; Zarrini, Parham ; Velleca, Angela ; Rush, Jenna ; Arabia, Francisco A. ; Trento, Alfredo ; Esmailian, Fardad. / Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 3. pp. 770-777.
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abstract = "Background: Vasoplegia is characterized as a severe vasodilatory shock after cardiac surgery, and can be associated with substantial morbidity. Increased systemic inflammation and endothelial dysfunction, often related to prolonged cardiopulmonary bypass times, anesthesia, or mechanical circulatory support have been shown to be associated with the development of vasoplegia. We sought to identify risk factors and the impact of various degrees of vasoplegia after heart transplantation. Methods: A retrospective review was conducted of 244 consecutive patients who underwent heart transplantation over a 3-year period. Patients were divided into three groups: no vasoplegia, mild vasoplegia (requiring one vasopressor), and moderate/severe vasoplegia (more than two vasopressors). One-year survival, freedom from rejection, and postoperative complication rates were assessed. Risk factors for vasoplegia subgroups were retrospectively identified. Results: Vasoplegia syndrome was observed in 34.3{\%} of patients after heart transplantation (mild, 74.1{\%}; moderate/severe, 25.9{\%}). Cardiopulmonary bypass time was significantly longer and pretransplant creatinine was significantly higher in the moderate/severe vasoplegia group. There was a strong trend toward greater use of mechanical circulatory support among moderate/severe vasoplegia patients compared with mild and no vasoplegia patients. After heart transplantation, 1-year survival, freedom from rejection, and need for hemodialysis were not significantly different between groups. Conclusions: Vasoplegia syndrome is common after heart transplantation. Risk factors for increased severity include longer cardiopulmonary bypass times and elevated preoperative creatinine. Although higher rates of mortality or graft rejection were not detected, vasoplegia was associated with prolonged intubation, greater blood product usage, and lengthened hospital stay. Further studies involving larger cohorts are warranted.",
author = "Chan, {Joshua L.} and Kobashigawa, {Jon A.} and Aintablian, {Tamar L.} and Dimbil, {Sadia J.} and Paul Perry and Patel, {Jignesh K.} and Kittleson, {Michelle M.} and Czer, {Lawrence S.} and Parham Zarrini and Angela Velleca and Jenna Rush and Arabia, {Francisco A.} and Alfredo Trento and Fardad Esmailian",
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T1 - Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation

AU - Chan, Joshua L.

AU - Kobashigawa, Jon A.

AU - Aintablian, Tamar L.

AU - Dimbil, Sadia J.

AU - Perry, Paul

AU - Patel, Jignesh K.

AU - Kittleson, Michelle M.

AU - Czer, Lawrence S.

AU - Zarrini, Parham

AU - Velleca, Angela

AU - Rush, Jenna

AU - Arabia, Francisco A.

AU - Trento, Alfredo

AU - Esmailian, Fardad

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: Vasoplegia is characterized as a severe vasodilatory shock after cardiac surgery, and can be associated with substantial morbidity. Increased systemic inflammation and endothelial dysfunction, often related to prolonged cardiopulmonary bypass times, anesthesia, or mechanical circulatory support have been shown to be associated with the development of vasoplegia. We sought to identify risk factors and the impact of various degrees of vasoplegia after heart transplantation. Methods: A retrospective review was conducted of 244 consecutive patients who underwent heart transplantation over a 3-year period. Patients were divided into three groups: no vasoplegia, mild vasoplegia (requiring one vasopressor), and moderate/severe vasoplegia (more than two vasopressors). One-year survival, freedom from rejection, and postoperative complication rates were assessed. Risk factors for vasoplegia subgroups were retrospectively identified. Results: Vasoplegia syndrome was observed in 34.3% of patients after heart transplantation (mild, 74.1%; moderate/severe, 25.9%). Cardiopulmonary bypass time was significantly longer and pretransplant creatinine was significantly higher in the moderate/severe vasoplegia group. There was a strong trend toward greater use of mechanical circulatory support among moderate/severe vasoplegia patients compared with mild and no vasoplegia patients. After heart transplantation, 1-year survival, freedom from rejection, and need for hemodialysis were not significantly different between groups. Conclusions: Vasoplegia syndrome is common after heart transplantation. Risk factors for increased severity include longer cardiopulmonary bypass times and elevated preoperative creatinine. Although higher rates of mortality or graft rejection were not detected, vasoplegia was associated with prolonged intubation, greater blood product usage, and lengthened hospital stay. Further studies involving larger cohorts are warranted.

AB - Background: Vasoplegia is characterized as a severe vasodilatory shock after cardiac surgery, and can be associated with substantial morbidity. Increased systemic inflammation and endothelial dysfunction, often related to prolonged cardiopulmonary bypass times, anesthesia, or mechanical circulatory support have been shown to be associated with the development of vasoplegia. We sought to identify risk factors and the impact of various degrees of vasoplegia after heart transplantation. Methods: A retrospective review was conducted of 244 consecutive patients who underwent heart transplantation over a 3-year period. Patients were divided into three groups: no vasoplegia, mild vasoplegia (requiring one vasopressor), and moderate/severe vasoplegia (more than two vasopressors). One-year survival, freedom from rejection, and postoperative complication rates were assessed. Risk factors for vasoplegia subgroups were retrospectively identified. Results: Vasoplegia syndrome was observed in 34.3% of patients after heart transplantation (mild, 74.1%; moderate/severe, 25.9%). Cardiopulmonary bypass time was significantly longer and pretransplant creatinine was significantly higher in the moderate/severe vasoplegia group. There was a strong trend toward greater use of mechanical circulatory support among moderate/severe vasoplegia patients compared with mild and no vasoplegia patients. After heart transplantation, 1-year survival, freedom from rejection, and need for hemodialysis were not significantly different between groups. Conclusions: Vasoplegia syndrome is common after heart transplantation. Risk factors for increased severity include longer cardiopulmonary bypass times and elevated preoperative creatinine. Although higher rates of mortality or graft rejection were not detected, vasoplegia was associated with prolonged intubation, greater blood product usage, and lengthened hospital stay. Further studies involving larger cohorts are warranted.

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