Vasoplegia after heart transplantation: outcomes at 1 year. (27th April 2017)

• Record Type: Journal Article
• Authors: Chan, Joshua L.; Kobashigawa, Jon A.; Aintablian, Tamar L.; Li, Yanqing; Perry, Paul A.; Patel, Jignesh K.; Kittleson, Michelle M.; Czer, Lawrence S.; Zarrini, Parham; Velleca, Angela; Rush, Jenna; Arabia, Francisco A.; Trento, Alfredo; Esmailian, Fardad
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 25:Number 2(2017)
• Page Start: 212
• Page End: 217
• Publication Date: 2017-04-27
• Subjects: Vasoplegia syndrome -- Heart transplantation -- Vasodilatory shock -- One-year outcomes; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivx081
• Languages: English
• ISSNs: 1569-9293

Abstract

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.