Vasoplegia is a common complication after heart failure surgery, although the incidence differs for each surgical procedure type. It is associated with poor early and late survival rates. In the... Show moreVasoplegia is a common complication after heart failure surgery, although the incidence differs for each surgical procedure type. It is associated with poor early and late survival rates. In the vasoplegic survivors, renal function is compromised compared to non-vasoplegic patients even though the cardiac function is similar. Preoperative factors associated with an increased risk on vasoplegia (e.g. anemia and a higher thyroxine levels) and factors associated with an decreased risk (e.g. higher creatinine clearance, beta-blocker use, prior hypertension) could be used to assess the risk on vasoplegia preoperatively for specific heart failure procedures. Also, intraoperative factors that are associated with an increased risk of vasoplegia (intraoperative vasoresponsiveness, longer cross clamp -, cardiopulmonary bypass - and procedure times) could be used to estimate the risk on vasoplegia. Further research is necessary to verify whether these results can be extrapolated to other hospitals and to validate the proposed risk model. Show less
Purpose Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no... Show morePurpose Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population. Methods Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures). Results The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study. Conclusions AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available. Show less
Vessem, M.E. van; Beeres, S.L.M.A.; Wilde, R.B.P. de; Vries, R. de; Berendsen, R.R.; Jonge, E. de; ... ; Palmen, M. 2019
