Sathianathan Shyama, Bhat Geetha, Dowling Robert
School of Medicine, Penn State College of Medicine, 500 University Dr, Hershey, PA, 17033, USA.
Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.
Curr Cardiol Rep. 2021 Jul 1;23(8):101. doi: 10.1007/s11886-021-01534-y.
The contribution of continuous flow left ventricular assist devices (c-LVAD) to vasoplegic syndrome and postoperative outcomes after orthotopic heart transplant (OHT) is contested in the literature. A standardized definition of vasoplegic syndrome (VS) is needed to better recognize and manage vasoplegic shock.
Vasoplegic syndrome occurs after orthotopic heart transplant more frequently than after other surgeries requiring cardiopulmonary bypass. c-LVADs lead to small vessel endothelial dysfunction and desensitized adrenal receptors; however, their contribution to the development of vasoplegia is debated in clinical studies. Pulsatility may mitigate vascular dysfunction resulting from long-term continuous flow, and should be further explored in the clinical setting when considering risk factors for vasoplegic syndrome. The incidence of vasoplegic syndrome after orthotopic heart transplant is rising with the increasing use of c-LVAD bridge to therapy. Robust clinical studies are needed to advance our understanding and approach to mitigating VS after OHT.
连续流左心室辅助装置（c-LVAD）对血管麻痹综合征及原位心脏移植（OHT）术后结局的影响在文献中存在争议。需要一个血管麻痹综合征（VS）的标准化定义，以更好地识别和处理血管麻痹性休克。
血管麻痹综合征在原位心脏移植后比在其他需要体外循环的手术中更频繁地发生。c-LVAD会导致小血管内皮功能障碍和肾上腺受体脱敏；然而，其在血管麻痹发展中的作用在临床研究中存在争议。搏动性可能减轻长期连续流导致的血管功能障碍，在考虑血管麻痹综合征的危险因素时，应在临床环境中进一步探索。随着c-LVAD桥接治疗的使用增加，原位心脏移植后血管麻痹综合征的发生率正在上升。需要开展有力的临床研究，以增进我们对减轻OHT后VS的理解和方法。
