Has Short-Term Mechanical Circulatory Support an Impact on Post-Heart Transplant Vasoplegia?

Abstract

To assess the impact of short-term mechanical circulatory support as bridge-to-urgent transplant on post-transplant vasoplegia. Single-center, retrospective review of all patients who underwent orthotopic heart transplantation between January 2012 and December 2018 (n=135). Patients with postoperative mechanical circulatory (n=9) support were excluded. Patients (n=126) were divided in two groups according to the preoperative use of short-term mechanical circulatory support (26 vs.100). Postoperative vasoplegia was defined as systemic vascular resistance (SVR) <800dynes/m2 with a CI above 3l/min/m2 and/or the use of methylene blue and/or cardiac index above 3l/min/m2 with >0,07mcgrs/kg/min of epinephrine or >0,5mcgrs/kg/min of norepinephrine. Postoperative SVR were calculated with a Swan-Ganz catheter at the arrival at the ICU. Patients mechanically supported showed higher preoperative use of inotropes (96,2% vs.22%, p<0,001), orotracheal intubation (88,46% vs.4% p <0,001) and renal dysfunction (30,8% vs.4%, p<0,001). Pre-transplant use of pulmonary vasodilators (7,7% vs.30%; p=0,02) and ACEIs was higher in the non-supported group (3,8%vs.49%, p<0,001). There was no difference in the incidence of post-transplant vasoplegia (26,9% vs.27%, p=0,99). Perioperative mortality (at discharge) was higher in the supported group (12% vs. 1% p=0,196) but it was not different regarding the incidence of vasoplegia (3,3% vs. 2,8% p= 1,0) CONCLUSION: Post-transplant vasoplegia was not influenced by the preoperative use of short-term mechanical circulatory support devices and was not associated with increased mortality in our series.