Vasoplegia After Cardiovascular Procedures—Pathophysiology and Targeted Therapy

Shahzad Shaefi, Aaron Mittel, John Klick, Adam Evans, Natalia S. Ivascu, Jacob Gutsche, John G.T. Augoustides

Research output: Contribution to journalReview articlepeer-review

48 Scopus citations

Abstract

Vasoplegic syndrome, characterized by low systemic vascular resistance and hypotension in the presence of normal or supranormal cardiac function, is a frequent complication of cardiovascular surgery. It is associated with a diffuse systemic inflammatory response and is mediated largely through cellular hyperpolarization, high levels of inducible nitric oxide, and a relative vasopressin deficiency. Cardiopulmonary bypass is a particularly strong precipitant of the vasoplegic syndrome, largely due to its association with nitric oxide production and severe vasopressin deficiency. Postoperative vasoplegic shock generally is managed with vasopressors, of which catecholamines are the traditional agents of choice. Norepinephrine is considered to be the first-line agent and may have a mortality benefit over other drugs. Recent investigations support the use of noncatecholamine vasopressors, vasopressin in particular, to restore vascular tone. Alternative agents, including methylene blue, hydroxocobalamin, corticosteroids, and angiotensin II, also are capable of restoring vascular tone and improving vasoplegia, but their effect on patient outcomes is unclear.

Original languageEnglish (US)
Pages (from-to)1013-1022
Number of pages10
JournalJournal of cardiothoracic and vascular anesthesia
Volume32
Issue number2
DOIs
StatePublished - Apr 2018

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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