Affiliation:
1. Department of Cardiovascular Diseases Mayo Clinic Rochester MN
Abstract
Background
The presence of a durable left ventricular assist device (
LVAD
) is associated with increased risk of vasoplegia in the early postoperative period following heart transplantation (
HT
). However, preoperative predictors of vasoplegia and its impact on survival after
HT
are unknown. We sought to examine predictors and outcomes of patients who develop vasoplegia after
HT
following bridging therapy with an
LVAD
.
Methods and Results
We identified 94 patients who underwent
HT
after bridging with continuous‐flow
LVAD
from 2008 to 2018 at a single institution. Vasoplegia was defined as persistent low vascular resistance requiring ≥2 intravenous vasopressors within 48 hours after
HT
for >24 hours to maintain mean arterial pressure >70 mm Hg. Overall, 44 patients (46.8%) developed vasoplegia after
HT
. Patients with and without vasoplegia had similar preoperative
LVAD
, echocardiographic, and hemodynamic parameters. Patients with vasoplegia were significantly older; had longer
LVAD
support, higher preoperative creatinine, longer cardiopulmonary bypass time, and higher Charlson comorbidity index; and more often underwent combined organ transplantation. In a multivariate logistic regression model, older age (odds ratio: 1.08 per year;
P
=0.010), longer
LVAD
support (odds ratio: 1.06 per month;
P
=0.007), higher creatinine (odds ratio: 3.9 per 1 mg/dL;
P
=0.039), and longer cardiopulmonary bypass time (odds ratio: 1.83 per hour;
P
=0.044) were independent predictors of vasoplegia. After mean follow‐up of 4.0 years after
HT
, vasoplegia was associated with increased risk of all‐cause mortality (hazard ratio: 5.20; 95% CI, 1.71–19.28;
P
=0.003).
Conclusions
Older age, longer
LVAD
support, impaired renal function, and prolonged intraoperative
CPB
time are independent predictors of vasoplegia in patients undergoing
HT
after
LVAD
bridging. Vasoplegia is associated with worse prognosis; therefore, detailed assessment of these predictors can be clinically important.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
20 articles.
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