Preoperative Vulnerability and Postoperative Recovery in Vasoplegia After Cardiac Surgery With Cardiopulmonary Bypass

Vasoplegia after cardiac surgery with cardiopulmonary bypass is an important cause of postoperative hemodynamic instability. This study evaluated clinical factors associated with vasoplegia and its association with delayed postoperative recovery.

Single-center retrospective observational study.

University hospital.

Adult patients undergoing cardiac or thoracic aortic surgery with cardiopulmonary bypass between January 2014 and December 2024.

None.

Vasoplegia was defined as simultaneous fulfillment of at least 3 of 4 hemodynamic criteria for more than 30 minutes between separation from cardiopulmonary bypass and 12 hours after intensive care unit admission: mean arterial pressure <60 mmHg, systemic vascular resistance index <1500 dyn·s/cm⁵/m², cardiac index >2.5 L/min/m², and vasopressor support. Among 572 patients, 101 (17.7%) developed vasoplegia. In multivariable logistic regression, lower geriatric nutritional risk index, impaired left ventricular systolic function, prior percutaneous coronary intervention, and aortic-involving surgery were independently associated with vasoplegia. Vasoplegia occurred in 13.9%, 13.7%, and 43.2% of patients with 0, 1, and 2 to 3 nutritional/functional deficits, respectively. After propensity score overlap weighting, vasoplegia was associated with prolonged mechanical ventilation ≥48 hours (odds ratio [OR], 2.20; 95% confidence interval (CI), 1.35-3.59), prolonged intensive care unit stay ≥7 days (OR, 2.08; 95% CI, 1.26-3.45), in-hospital mortality (OR, 3.09; 95% CI, 1.02-9.32), and composite poor postoperative outcome (OR, 2.03; 95% CI, 1.26-3.29).

Vasoplegia after cardiopulmonary bypass was associated with preoperative nutritional/functional vulnerability, impaired ventricular function, prior percutaneous coronary intervention, aortic surgical exposure, and delayed early postoperative recovery after measured-risk balancing.