Predictors and Impact of Prolonged Vasoplegia After Continuous-Flow Left Ventricular Assist Device Implantation

Authors

Harveen K Lamba
Mary Kim
Meng Li
Andrew B Civitello
Ajith P Nair
Leo Simpson
J Patrick Herlihy
O H Frazier
Joseph G Rogers
Gabriel Loor
Kenneth K Liao
Alexis E Shafii
Subhasis Chatterjee

Publication Date

5-1-2024

Journal

Advances - JACC

DOI

10.1016/j.jacadv.2024.100916

PMID

38939630

PMCID

PMC11198707

PubMedCentral® Posted Date

3-26-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Abstract

BACKGROUND: Vasoplegia after cardiac surgery is associated with adverse outcomes. However, the clinical effects of vasoplegia and the significance of its duration after continuous-flow left ventricular assist device (CF-LVAD) implantation are less known.

OBJECTIVES: This study aimed to identify predictors of and outcomes from transient vs prolonged vasoplegia after CF-LVAD implantation.

METHODS: The study was a retrospective review of consecutive patients who underwent CF-LVAD implantation between January 1, 2005, and December 31, 2017. Vasoplegia was defined as the presence of all of the following: mean arterial pressure ≤65 mm Hg, vasopressor (epinephrine, norepinephrine, vasopressin, or dopamine) use for >6 hours within the first 24 hours postoperatively, cardiac index ≥2.2 L/min/m

RESULTS: Of the 600 patients who underwent CF-LVAD implantation during the study period, 182 (30.3%) developed vasoplegia. Mean patient age was similar between the vasoplegia and no-vasoplegia groups. Prolonged vasoplegia (n = 78; 13.0%), compared with transient vasoplegia (n = 104; 17.3%), was associated with greater 30-day mortality (16.7% vs 5.8%;

CONCLUSIONS: Compared with vasoplegia overall, prolonged vasoplegia was associated with worse survival after CF-LVAD implantation. Treatment to avoid or minimize progression to prolonged vasoplegia may be warranted.

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