Outcomes and Risk Factors for Postoperative Vasoplegia Following Implant of Left Ventricular Assist Devices

Postoperative vasoplegia syndrome (PVS) following cardiac surgery has previously been associated with poor survival. This study aimed to investigate outcomes and predictors of PVS following left ventricular assist device implantation.

This was a retrospective study of 190 left ventricular assist device recipients at The Ohio State University. Primary outcomes included hospitalization duration, right-sided heart failure, and mortality. Risk factor evaluation included multivariate analysis of cardiovascular comorbidities and perioperative medication use. Patients were stratified into PVS (n=50, 26.3%) and non-PVS cohorts.

On univariate analysis, PVS was associated with male sex (94% versus 67%, P=0.0004) and higher body mass index (32.5 versus 29.0, P=0.0011). Further, PVS was associated with diabetes (60.0% versus 41.4%, P=0.036), higher preoperative hemoglobin A_1c levels (6.8% versus 6.3%, P=0.0354), and higher rates of microvascular complications (28.0% versus 12.9%, P=0.014). Preoperatively, patients without PVS were more likely to receive dobutamine (58.6% versus 34.0%, P=0.004) and at higher dosages (2.9 versus 1.9 μg/kg per min, P=0.0196). Primary outcomes, including mortality, were similar between groups. Multivariate analysis demonstrated male sex (odds ratio [OR], 9.43 [95% CI, 2.93-43.6]) and higher body mass index (OR, 1.11, [95% CI, 1.04-1.18]) as independent risk factors. HeartMate 3 implantation (OR, 0.33 [95% CI, 0.10-0.97]) and preimplant dobutamine infusion (OR, 0.28 [95% CI, 0.12-0.61]) were protective factors.

PVS did not confer inferior outcomes after left ventricular assist device implantation but was associated with male sex and higher body mass index. Preoperative dobutamine was more commonly used in patients without PVS, warranting further investigation.