Predictors and Clinical Outcomes of Vasoplegia in Patients Bridged to Heart Transplantation with Continuous Flow Left Ventricular Assist Devices

Abstract

Purpose Vasoplegia has been implicated in adverse outcomes after heart transplantation (HT). Although left ventricular assist device (LVAD) is associated with increased risk of vasoplegia, pre-operative predictors of vasoplegia in this population and its impact on survival after HT are unknown. In this study, we sought to examine predictors and outcomes of patients who develop vasoplegia after HT following bridging therapy with continuous flow LVAD. Methods We retrospectively analyzed 94 patients who underwent HT after bridging with LVAD between July, 2008 and June, 2018 at a large institution. Vasoplegia was defined as persistent low vascular resistance requiring ≥2 intravenous vasopressors within 48 hours post HT for >24 hours to maintain a mean arterial pressure >70 mm Hg. Logistic regression was used to examine predictors of vasoplegia and the association with survival was examined using Cox proportional hazard regression. Results Overall, 44 (46.8%) patients with LVAD developed vasoplegia after HT. Patients with and without vasoplegia had similar pre-operative LVAD, echocardiographic, and hemodynamic parameters. Patients with vasoplegia were significantly older, had longer LVAD support, higher pre-operative creatinine, cardiopulmonary bypass time (CBT), and Charlson comorbidity index, and had higher rates of hypothyroidism and sustained ventricular tachycardia (VT) (all p Conclusion Longer LVAD support, impaired renal function, sustained VT, and prolonged intra-operative CBT are independent predictors of vasoplegia in patients undergoing HT after LVAD bridging. Vasoplegia is associated with poor prognosis; hence, detailed assessment of these predictors can be clinically important.