Risk factors and outcomes for 'vasoplegia syndrome' following cardiac transplantation

Objective: Vasoplegia syndrome after orthotopic heart transplantation (OHT) is a rare but highly lethal syndrome of unknown etiology, characterized by severe refractory hypotension, metabolic acidosis, and decreased systemic vascular resistance (SVR). The objective of this retrospective study was to identify the risk factors contributing to the development of vasoplegia syndrome after OHT in order to provide potential algorithms for its management. Methods: Between October 1992 and July 2001, 187 consecutive patients underwent OHT. Complete pre- and post-data were available in 147 patients (78%). Mean age was 49 +/- 11 years, 82% (120/147) were male, and donor ischemic time was 117 +/- 62 min. Twenty-eight of 147 (19%) developed vasoplegia syndrome, defined as SVR <800 dyn s per cm(5) with serum bicarbonate <20 mEq/l. Results: Patients who developed vasoplegia syndrome demonstrated greater hospital mortality (25 vs. 9%, P = 0.031) compared to those who did not. Multivariate logistic regression identified pre-operative use of intravenous heparin (OR 2.8, CI 1-7.4, P = 0.039) and body surface area >1.9 m(2) (OR 7, Cl 0.98-50, P = 0.052) as independent predictors for the development of postoperative vasoplegia syndrome. Pre-operative use of inotropic support conferred protection against the development of post-operative vasoplegia syndrome (OR 0.25, CI 0.08-0.79, P = 0.018). Pre-operative use of ACE inhibitors was not associated with increased risk (55 vs. 59%, P = 0.441). Conclusions: Vasoplegia syndrome following OHT is associated with high early mortality. The development of a risk stratification profile may help in patient selection as well as the post-operative management of vasoplegia syndrome following OHT. (C) 2003 Elsevier B.V. All rights reserved.