The Effect of Postoperative Vasoplegia to the Survival of LVAD Recipients

Purpose Vasoplegia syndrome (VS) is characterized by decreased systemic vascular resistance, refractory hypotension, and metabolic acidosis. VS can develop during and after left ventricular assist device (LVAD) implantation, which significantly complicates postoperative management. However, because of the limited prior studies, the causes, risk factors, and the effect of VS on outcomes are not well known. The aim of the study is to analyze the effect of VS in our cohort. Methods From January 2015 through February 2018, 134 patients with chronic end-stage heart failure underwent primary LVAD implantation in our single center. We defined vasoplegia as patients with normal cardiac index requiring >24-hour use of intravenous vasopressors within 48 hours following primary LVAD implantation to maintain a mean arterial pressure >70 mmHg, as previously reported. Patients were grouped as VS group and non-VS group. Pre- and intraoperative demographics, short- and long-term survival were analyzed between the groups. Correlation between VS and mortality, as well as independent risk factors for VS, were analyzed using Cox regression models. Results 134 patients were stratified into 2 groups: VS group (n=91) and non-VS group (n=43). Cox univariate analysis demonstrated VS was not an independent predictor for mortality (Hazard Ratio (HR) 0.74, p=0.41, 95% Confidence interval (CI) 0.36-0.74). Cox multivariate analysis revealed preoperative elevated Alanine Aminotransferase (ALT) was an independent predictor for VS occurrence (HR 1.001, p=0.003, 95% CI 1.000-1.002). Kaplan Meier curve showed no statistical difference in survival on LVAD between 2 groups. (p=0.20) Conclusion In our cohort, VS was not associated with higher mortality on LVAD support. Patients with preoperative elevated ALT may benefit from optimization prior to implantation to prevent VS. Additional researches are required to further explore VS mechanism and understand the effect on LVAD population outcomes.