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Profound Vasoplegia During Sacubitril/Valsartan Treatment After Heart Transplantation

Aws Almufleh1, Lisa M Mielniczuk2, Radoslav Zinoviev3

  • 1Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia.

The Canadian Journal of Cardiology
|February 6, 2018
PubMed

Insights

Sacubitril/valsartan may cause severe hypotension after heart transplantation (HT), leading to complications like acute kidney injury. Consider withholding this medication before HT in at-risk patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Vasoplegia is a serious complication after heart transplantation (HT), affecting up to 16% of patients.
  • It is linked to increased morbidity and mortality, posing a significant clinical challenge.

Observation:

  • A 61-year-old man with ischemic cardiomyopathy developed profound hypotension post-HT while on sacubitril/valsartan.
  • Despite treatment with methylene blue and vasopressors, he experienced acute kidney injury requiring dialysis and prolonged ICU stay.

Findings:

  • This case highlights a potential potent vasodilatory effect of sacubitril/valsartan.
  • The drug may exacerbate or contribute to vasoplegia in the post-HT setting.

Implications:

  • Clinicians should consider the potential for severe hypotension when patients on sacubitril/valsartan undergo HT.
  • Withholding sacubitril/valsartan before HT, especially in patients with vasoplegia risk factors, may be warranted.
  • Further studies are needed to confirm these findings and guide clinical practice.

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