Impact of Vasoplegic Syndrome on Early Clinical Outcome after Orthotopic Heart Transplantation

Background: Vasoplegic syndrome is a possible complication after cardiac surgery using cardiopulmonary bypass (CPB) and is mainly characterized by a loss of systemic resistance leading to refractory hypotension and inadequate peripheral tissue perfusion. The objective of this retrospective study is to determine the impact of vasoplegic syndrome on short- and long-term morbidity and mortality after heart transplantation.

Method: We retrospectively reviewed data of 156 consecutive adult patients who underwent heart transplantation at our center between 2010 and 2021. Vasoplegic syndrome was defined as persistent low systemic vascular resistance (<800 dynes/s/cm⁵) with preserved cardiac index (>2.5 L/min/m²) and catecholamine resistant hypotension despite intravenous vasopressors at a high dose (>0.2 µg/kg/min norepinephrine) within the first 6 to 24 hours after surgery. Patients were divided into two group classified by the presence or absence of vasoplegia.

Results: The incidence of vasoplegia was 11.5% (18 patients) with comparable donor and recipient characteristics in both groups. The mean age of vasoplegic patients was 51 ± 10 (vs. 50 ± 12) years and 88.9% (vs. 71.0%) were male. 61.6% (vs. 48.1%) had a history of prior cardiac surgery of which 44.4% (vs. 28.1%) were implantations of left ventricular assist devices.

Vasoplegic patients showed increased lactate levels at the end of CPB (9.0 ± 5.3 vs. 4.9 ± 3.1 mmol/L, p < 0.001) and higher rate of reoperation for bleeding (55.6% vs. 15.2%, p < 0.001). Of the 18 vasoplegic patients, 5 patients (27.8%) received immediate mechanical circulatory support (MCS) at the end of CPB for a mean of 5 ± 2.7 days, six patients (33.3%) received delayed MCS after a mean of 7.8 ± 5.7 hours postoperatively for 6.1 ± 4.6 days, and seven patients (38.9%) were treated without MCS.

Thirty-day survival rates were 100% in patients receiving immediate MCS, 50% in patients with delayed MCS and 71.4% in patients without MCS, respectively. Overall 30-day survival rate was lower in vasoplegic patients (72.2 vs. 94.9%, p < 0.001). If patients survived the first 30 days there was no significant difference in 1-year survival (92.3 vs. 90.2%).

Conclusion: Vasoplegic syndrome following heart transplantation was associated with increased perioperative 30-day mortality. Early MCS implantation seemed to be beneficial for short-term survival. Vasoplegic patients surviving the first 30 days had a comparable and good long-term outcome.

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Artikel online veröffentlicht:
03. Februar 2022