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. 2020 May;12(5):2426-2434.
doi: 10.21037/jtd.2020.03.53.

Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes

Jason M Ali  1 , Serena Patel  1 , Pedro Catarino  1 , Alain Vuylsteke  2 , Stephen Pettit  3 , Sai Bhagra  3 , Anna Kydd  3 , Clive Lewis  3 , Jayan Parameshwar  3 , Pradeep Kaul  1 , Catherine Sudarshan  1 , Steven Tsui  1 , David Jenkins  1 , Yasir Abu-Omar  1 , Marius Berman  1
Affiliations

Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes

Jason M Ali et al. J Thorac Dis. 2020 May.

Abstract

Background: Vasoplegia has been associated with inferior outcomes following heart transplantation (HTx). This observational study was designed to investigate outcomes in recipients with vasoplegia following left ventricular assist device (LVAD) explant HTx.

Methods: Patients undergoing LVAD explant followed by HTx from 01/2013-12/2018 at our centre were included. Vasoplegia was defined as the requirement for high dose vasopressor [noradrenaline (>0.5 μg/kg/min) and vasopressin (>1 U/h)] over the first 24 hours following HTx. Demographic and outcome data were retrieved from the transplant unit database.

Results: During the study period 24 patients underwent LVAD explant HTx. Of these, 13 (54.2%) developed vasoplegia. Both groups had similar duration of LVAD support (median 684 vs. 620 days P=0.62). There was a higher incidence of driveline infection in patients developing vasoplegia (69.2% vs. 18.2% P=0.02). HTx following donation after circulatory death (DCD) occurred in 9 (37.5%) patients and was not associated with a higher incidence of vasoplegia (P=0.21). Vasoplegia developed early following reperfusion and intensive care unit admission vasopressor-inotrope scores were significantly higher in patients with vasoplegia (P=0.002). Patients developing vasoplegia had similar ICU (P=0.79) and hospital (P=0.93) lengths of stay. Survival was equivalent both at 30-day (92.3% vs. 100% P=0.99) and 1-year (67.7% vs. 74.7% P=0.70). Our overall HTx 1-year survival was 89.3% over this period.

Conclusions: Vasoplegia is seen with a high incidence in HTx recipients bridged with an LVAD. This appears to be associated with the presence of driveline infections. Early aggressive management is advocated, resulting in equivalent 1-year survival to those patients not developing vasoplegia.

Keywords: Vasoplegia; continuous flow; heart transplantation (HTx); left ventricular assist device (LVAD).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.53). JMA serves as an unpaid editorial board member of Journal of Thoracic Disease from Oct 2019 to Sep 2021. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier survival estimates for patients developing and not developing vasoplegia following heart transplantation with LVAD explant. LVAD, left ventricular assist device.
See this image and copyright information in PMC

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