Predictors and Impact of Vasoplegia after Continuous-Flow Left Ventricular Assist Device Implantation

Purpose We identified the impact of vasoplegia after left ventricular assist device (LVAD) on postoperative outcomes and predictors of postoperative vasoplegia. Methods Retrospective review of 624 patients who had continuous flow LVAD implantation from 2005-2017 at our institution. Mild, moderate, or severe vasoplegia was determined with the vasoactive score (VS) [dopamine+100 x epinephrine + 100 x norepinephrine + 10000 x vasopressin] (U/kg/min), with a VS of 28 being severe. Mean VS was calculated at 0-6 hrs, 6-12 hrs, and 12-24 hrs postoperatively. Results Mean age was similar for vasoplegic and non-vasoplgic patients (Table 1). Vasoplegia was observed in 134 (21.5%) patients. Reoperation for bleeding and 30-day mortality were higher in vasoplegic patients (Table 1). VS at 12-24 hrs had a greater association with 30-day mortality compared to VS at 0-6 or 6-12 hrs (AUC 0.72 vs 0.69 vs 0.65; p Conclusion Moderate to severe vasoplegia at 12 to 24 hrs postoperatively is associated with significantly worse survival after CF-LVAD implantation. Modifiable risk factors identified in this study should be optimized to reduce risk of vasoplegia.