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Incidence and Impact of On-Cardiopulmonary Bypass Vasoplegia During Heart Transplantation

Truby, Lauren K.; Takeda, Koji; Farr, Maryjane; Beck, James; Yuzefpolskaya, Melana; Colombo, Paolo C.; Tokpara, Veli; Mancini, Donna; Naka, Yoshifumi; Takayama, Hiroo
doi: 10.1097/MAT.0000000000000623
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Despite significant advances in the medical management of heart transplant (HT) recipients, perioperative complications, including vasoplegia, remain a significant contributor to morbidity and mortality. This is a retrospective review of patients who received HT at our institution between 2012 and 2015. Mean systemic vascular resistance (SVR) was calculated during the bypass run. Vasoplegia was defined as a mean SVR <800 dynes s/cm5 despite a high pressor requirement (>1,500 μg neosynephrine bolused). The primary outcome of interest was 30 day post-transplant survival. There were 138 patients included in the current study. A total of 16% (n = 22) patients were identified as having developed on-cardiopulmonary bypass vasoplegia. Vasoplegic patients had a significantly higher body mass index (BMI) (30.1 ± 5.0 vs. 26.5 ± 4.7; p = 0.005) and were more likely to be male (95.5% vs. 66.4%; p = 0.004). Use of continuous-flow left ventricular assist device (CF-LVAD) as bridge-to-transplant (BTT) was prevalent among vasoplegic patients (81.8% vs. 57.8%; p = 0.033). These patients had significantly decreased survival at 30 and 60 days (86.4% vs. 99.1% at 30 days; 77.3% vs. 92.8% at 60 days). Bridge-to-transplant with CF-LVAD was an independent predictor of on-cardiopulmonary bypass (CPB) vasoplegia. On-CPB vasoplegia complicated 16% of HTs in the current study and was associated with increased mortality. Bridge-to-transplant with CF-LVAD was an independent predictor of this phenomenon.

Submitted for consideration November 2016; accepted for publication in revised form June 2017.

Disclosure: Yoshifumi Naka receives a consultant fee from Thoratec corporation. The other authors have no conflicts of interest to report.

Correspondence: Hiroo Takayama, Department of Medicine, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY 10032. Email: hirofu2@hotmail.com.

Copyright © 2017 by the American Society for Artificial Internal Organs