Risk factors for vasoplegia after cardiac surgery: a meta-analysis

Postoperative vasoplegia (PV) is a common haemodynamic disorder after cardiac surgery and is associated with high operative mortality. Preventive and potent therapeutic measures are critical to improve the outcome. Identification of risk factors for PV may increase awareness and prompt therapeutic action. Our objective was to pool the available evidence on the risk factors for PV in cardiac surgery and to perform a meta-analysis.

PubMed, Embase, Ovid and Google Scholar databases were searched for studies published between 1965 and 2017. Three investigators independently screened the studies and extracted the data. Pooled estimates were obtained by a random effects model. Preoperative and operative patient data were gathered to determine their association with PV.

The search yielded 109 potential studies for inclusion. Of these, 10 articles were analysed and their data extracted. The total number of patients included was 30 035 patients (1524 with vasoplegia and 28 511 without vasoplegia). The only preoperative variable that was significantly associated with PV was renal failure [odds ratio (OR) 1.47; 95% confidence interval (CI) 1.17-1.86]. Patients with isolated coronary artery bypass grafting had a lower risk for PV (OR 0.36; 95% CI 0.22-0.59), whereas previous cardiac surgery (OR 2.03; 95% CI 1.27-3.26) and combined procedures increased its incidence (OR 2.12; 95% CI 1.82-2.47). PV increased with higher use of red blood cells (OR 2.12; 95% CI 1.82-2.47), longer aortic cross-clamp (mean difference 8.15 min; 95% CI 8.79-27.50 min) and cardiopulmonary bypass (mean difference 25.72 min; 95% CI 12.75-38.69 min) duration.

Patients with renal failure, higher use of red blood cell, longer and combined cardiac surgery procedures are at a higher risk for PV. Measures to promptly identify and treat PV in these patients should be considered.