Cedars-Sinai Heart Institute, Los Angeles, California; Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Cedars-Sinai Heart Institute, Los Angeles, California.
Ann Thorac Surg. 2018 Mar;105(3):770-777. doi: 10.1016/j.athoracsur.2017.09.039. Epub 2017 Dec 28.
Vasoplegia is characterized as a severe vasodilatory shock after cardiac surgery, and can be associated with substantial morbidity. Increased systemic inflammation and endothelial dysfunction, often related to prolonged cardiopulmonary bypass times, anesthesia, or mechanical circulatory support have been shown to be associated with the development of vasoplegia. We sought to identify risk factors and the impact of various degrees of vasoplegia after heart transplantation.
A retrospective review was conducted of 244 consecutive patients who underwent heart transplantation over a 3-year period. Patients were divided into three groups: no vasoplegia, mild vasoplegia (requiring one vasopressor), and moderate/severe vasoplegia (more than two vasopressors). One-year survival, freedom from rejection, and postoperative complication rates were assessed. Risk factors for vasoplegia subgroups were retrospectively identified.
Vasoplegia syndrome was observed in 34.3% of patients after heart transplantation (mild, 74.1%; moderate/severe, 25.9%). Cardiopulmonary bypass time was significantly longer and pretransplant creatinine was significantly higher in the moderate/severe vasoplegia group. There was a strong trend toward greater use of mechanical circulatory support among moderate/severe vasoplegia patients compared with mild and no vasoplegia patients. After heart transplantation, 1-year survival, freedom from rejection, and need for hemodialysis were not significantly different between groups.
Vasoplegia syndrome is common after heart transplantation. Risk factors for increased severity include longer cardiopulmonary bypass times and elevated preoperative creatinine. Although higher rates of mortality or graft rejection were not detected, vasoplegia was associated with prolonged intubation, greater blood product usage, and lengthened hospital stay. Further studies involving larger cohorts are warranted.
心脏手术后出现的血管麻痹综合征是一种严重的血管扩张性休克，可能导致严重的发病率。全身性炎症和内皮功能障碍的增加，通常与心肺转流时间延长、麻醉或机械循环支持有关，与血管麻痹综合征的发生有关。我们试图确定风险因素以及心脏移植后不同程度的血管麻痹综合征的影响。
对 3 年内 244 例连续接受心脏移植的患者进行回顾性分析。患者分为三组：无血管麻痹、轻度血管麻痹（需要一种血管加压药）和中重度血管麻痹（需要两种以上血管加压药）。评估 1 年生存率、无排斥反应和术后并发症发生率。回顾性确定血管麻痹亚组的危险因素。
心脏移植后 34.3%的患者出现血管麻痹综合征（轻度 74.1%；中重度 25.9%）。中重度血管麻痹组的心肺转流时间明显延长，术前肌酐明显升高。与轻度和无血管麻痹患者相比，中重度血管麻痹患者更倾向于使用机械循环支持。心脏移植后，1 年生存率、无排斥反应率和需要血液透析率在各组间无显著差异。
心脏移植后血管麻痹综合征很常见。严重程度增加的危险因素包括心肺转流时间延长和术前肌酐升高。尽管未发现死亡率或移植物排斥率较高，但血管麻痹与延长插管、更多血液制品使用和延长住院时间有关。需要更大规模的队列研究。
