Vasoplegia after heart transplantation: Outcomes at 1 year

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

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

OBJECTIVES: Vasoplegia syndrome is a potentially life-threatening condition that can occur following cardiopulmonary bypass. Heart transplantation is a recognized risk factor for developing this vasodilatory state. The objective of this study was to determine the effects of vasoplegia syndrome on 1-year heart transplant outcomes. METHODS: A retrospective review of orthotopic heart transplants at a single institution between November 2010 and December 2014 was performed. Of the 347 consecutive adult patients, 107 patients (30.8%) met criteria for vasoplegia syndrome. Preoperative factors and intraoperative variables were collected and compared between vasoplegia and non-vasoplegia cohorts. The incidence of postoperative complications, transplant rejection and patient survival within 1 year were evaluated. RESULTS: Demographics and preoperative medication profiles were similar in both groups, while mechanical circulatory support device use was associated with vasoplegia syndrome (30.8% vs 20.0%; P = 0.039). Perioperative characteristics such as longer cardiopulmonary bypass [165.0 (interquartile range [IQR] 74) min vs 140.0 (IQR 42.7) min; P < 0.001] and increased blood product usage (24.7 ± 17.2 units vs 17.7 ± 14.3 units; P < 0.001) were associated with vasoplegia. Non-vasoplegia patients were more likely to be extubated [42.9 (IQR 37.3) h vs 66.8 (IQR 50.2) h; P < 0.001] and discharged earlier [10.0 (IQR 6) days vs 14.0 (IQR 11.5) days; P < 0.001]. One-year patient survival (92.0% vs 88.6%; P = 0.338) and any-treated rejection rates (82.7% vs 84.3%; P = 0.569) were not significantly different between groups. CONCLUSIONS: Although vasoplegia syndrome was associated with an increase in perioperative morbidity, including greater mechanical ventilation time and hospital length of stay, no significant differences in survival or allograft rejection at 1 year was demonstrated.

Original languageEnglish (US)
Pages (from-to)212-217
Number of pages6
JournalInteractive Cardiovascular and Thoracic Surgery
Volume25
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Keywords

  • Heart transplantation
  • One-year outcomes
  • Vasodilatory shock
  • Vasoplegia syndrome

ASJC Scopus subject areas

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

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