Vasoplegic Syndrome during Left Ventricular Assist Device Insertion: A Systematic Review and Meta-Analysis

To determine the incidence of vasoplegic syndrome (VS) following durable left ventricular assist device (LVAD) insertion and to identify associated risk factors and clinical outcomes.

Systematic review and meta-analysis conducted per PRISMA guidelines, with risk of bias assessed using the Newcastle-Ottawa Scale. Meta-analysis calculated relative risks (RR), odds ratios (OR), and weighted mean differences (WMD).

Systematic search of MEDLINE and EMBASE from inception to May 1, 2026.

Adults undergoing durable LVAD insertion across 16 retrospective studies, encompassing 3,121 LVAD insertions with 1,093 identified VS cases.

Durable LVAD insertion via cardiopulmonary bypass (CPB).

The pooled VS incidence was 36.30% (95% CI: 34.61%-38.02%). Risk factors included male sex (RR 1.65, p = 0.008), INTERMACS profile ≤2 (RR 1.19, p = 0.009), repeat sternotomy (RR 1.30, p = 0.020), concomitant procedures (RR 1.27, p = 0.003), and longer CPB duration (WMD 13.17 minutes, p < 0.001). VS was associated with increased right ventricular failure (OR 1.76, p < 0.001), renal replacement therapy (OR 1.77, p < 0.001), reoperation for bleeding (OR 2.46, p < 0.001), and prolonged ICU stay (10.00 v 6.34 days, p < 0.001). Mortality was significantly higher in patients with VS at both 30 days (14.85% v 5.63%, p < 0.001) and 1 year (33.88% v 22.62%, p = 0.030).

VS affects approximately one-third of LVAD recipients and is associated with substantially increased postoperative morbidity and mortality. The identified risk factors support preoperative risk stratification and the development of targeted intervention strategies.