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Vasoplegic syndrome after open heart surgery

W J Gomes1, A C Carvalho, J H Palma

  • 1Cardiovascular Surgery Discipline, Escola Paulista de Medicina and São Paulo Hospital-Federal University of São Paulo, SP, Brazil.

The Journal of Cardiovascular Surgery
|December 2, 1998
PubMed
Summary

Postperfusion vasoplegic syndrome after cardiopulmonary bypass (CPB) surgery increases patient risk. This condition requires high-dose vasopressors and is linked to significant morbidity and mortality.

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Area of Science:

  • Cardiovascular Surgery
  • Intensive Care Medicine
  • Anesthesiology

Background:

  • A novel postperfusion syndrome, vasoplegic syndrome, is described in the postoperative phase following cardiopulmonary bypass (CPB).
  • This syndrome presents with distinct hemodynamic characteristics and requires specific management strategies.

Purpose of the Study:

  • To detail the clinical and hemodynamic features of vasoplegic syndrome post-CPB.
  • To highlight the associated morbidity and mortality risks.

Main Methods:

  • Retrospective analysis of sixteen patients undergoing cardiovascular surgery with CPB.
  • Patients exhibited hypotension, tachycardia, normal/high cardiac output, low systemic vascular resistance, and decreased filling pressures.
  • CPB techniques included hypothermic (28°C) in most patients with hypothermic blood cardioplegia.

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Main Results:

  • Patients required high-dose norepinephrine for blood pressure control without typical peripheral vasoconstriction.
  • Oliguria and hypotension persisted despite fluid administration.
  • The syndrome is associated with increased morbidity (most patients), mortality (4 deaths), and shares similarities with septic shock, potentially mediated by cytokines.

Conclusions:

  • Vasoplegic syndrome significantly increases operative morbidity and early postoperative risks.
  • Prompt recognition and management are crucial to mitigate adverse outcomes.