Risk Factors and Clinical Significance of Vasoplegia after LVAD Implantation

Abstract

<h3>Purpose</h3> To assess the performance of several post cardiac surgery vasoplegia definitions in a large, single center continuous-flow left ventricular assist device (CF-LVAD) cohort. <h3>Methods</h3> A single center first-time, CF-LVAD dataset was utilized for this analysis (n=505). Vasoactive drips and hemodynamics were collected at the following time points in all subjects with available data: pre-op, immediate post-op, and on post-operative days 1, 2, and 3 (n=325). For each of the four vasoplegia definitions tested (table), infusion requirements for each definition were converted to an equivalent vasoactive intropes score (VIS). VIS were then cacluated for each patient, at each time point, and utilzied to determine if vasoplegia criteria were met. To test the assoication between vasoplegia and post LVAD mortality, logistic regression (60-day death as outcome) and cox regression analyses were performed. To assess for clinical predictors of post-opertive vasoplegia, a mutivariable logisitic regression was performed. <h3>Results</h3> Among the vasoplegia definitions tested, the Patarroyo definition had the strongest association with death at 60 days (OR 3.55, 95 % CI 1.48-8.52, p=0.005). This defintion was met by 14% of cohort subjects with available data. Variables associated with the development of vasoplegia using this definition in the mutivariate models inlcuded higher creatinine, longer cardiopulmonary bypass time, prior cardiothoracic sugery and lower INTERMACS profile. Two of the vasoplegia definitions tested (Levin, Unified) had little utility to classify vasoplegia due to the requirement for mean arterial pressure to be less than 50 mm Hg. <h3>Conclusion</h3> Among the post-cardiothoracic surgery vasoplegia definitions tested, the Patrroyo was the most highly associated with early post LVAD mortality in this dataset. Risk factors for vasoplegia were similar to previous published reports. Use of VIS simplified the process of determining vasoplegia infusion. criteria