Abstract
PurposeVasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response induced by extracorporeal circulation represents the major determinant, but adrenal insufficiency and postoperative vasopressin deficiency may have a role. Pathophysiological meaning of perioperative changes in endocrine markers of hydro-electrolyte balance has not still fully elucidated. Objectives of the present research study were to estimate the incidence of vasoplegia in a homogeneous cohort of not severe cardiopathic patients, to define the role of presurgical adrenal insufficiency, to evaluate copeptin and NT-proBNP trends in the perioperative.MethodsWe conducted a prospective cohort study in the cardiac intensive care unit of a tertiary referral center. We evaluated 350 consecutive patients scheduled for cardiac surgery; 55 subjects completed the study. Both standard and low-dose corticotropin stimulation tests were performed in the preoperative; copeptin and NT-proBNP were evaluated in the preoperative (T0), on day 1 (T1) and day 7 (T2) after surgery.ResultsNine subjects (16.3%) developed vasoplegic syndrome with longer bypass and clamping time (p < 0.001). Reduced response to low-dose ACTH test was not associated to vasoplegia. Preoperative copeptin > 16.9 pmol/L accurately predicted the syndrome (AUC 0.86, 95% CI 0.73–0.94; OR 1.17, 95% CI 1.04–1.32). An evident correlation was observed at 7 days postoperative between NT-proBNP and copeptin (r 0.88, 95% CI 0.8–0.93; p < 0.001).ConclusionPreoperative impaired response to low-dose ACTH stimulation test is not a risk factor for post-cardiotomic vasoplegia; conversely, higher preoperative copeptin predicts the complication. On-pump cardiac surgery could be an interesting model of rapid heart failure progression.
Highlights
Postoperative vasodilatory shock is a common complication after major cardiac surgery
All patients scheduled for cardiopulmonary bypass (CPB) cardiac surgery and subsequent admission to the Cardiac Intensive Care Unit were consecutively evaluated for enrollment
We consecutively evaluated 350 patients admitted to the cardiac surgery ward; 253 of them were ineligible according with the exclusion criteria
Summary
Postoperative vasodilatory shock is a common complication after major cardiac surgery. It occurs in 5–45% of the procedures and is observed mostly among on-pump intervention [1,2,3,4]. This condition has been defined as post-cardiotomy vasoplegic syndrome (PCVS) and is characterized by reduced vascular tone, tissue hypoperfusion and metabolic acidosis [1, 4, 5]. PCVS represents the second cause of vasoplegic shock after sepsis; other well-known associated conditions are major surgical interventions (e.g., organ transplantation), multi-organ failure as a result of burns or multiple traumas, severe pancreatitis [1].
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