Risk Factors and Early Outcomes of Vasoplegia Syndrome (VS) after Heart Transplantation in CF-LVAD Patients

Abstract

Purpose VS in heart transplantation has been associated with adverse survival outcomes. We evaluated risk factors for and early outcomes of VS amongst CF-LVAD patients undergoing OHT. Methods Single center, retrospective cohort of all adult CF-LVAD BTT patients between 5/2013 to 5/2018. VS was defined as profound vasodilatory shock (SVR ≤ 800 dynes/s/cm−5) with a preserved cardiac index (CI ≥2.2 L/min/m2) requiring vasopressor support (vasopressor score ≥ 4) within 48hrs post OHT. Vasopressor score = (epinephrine dose x 100 μg/kg/min) + (norepinephrine dose x 100 μg/kg/min) + (vasopressin dose x 10000 units/kg/min) + (phenylephrine dose x 100 μg/kg/min). Pulsatility Index (PI) of HM II CF-LVAD at index admission was obtained as a surrogate marker of pulsatility. Results Eighty-four CF-LVAD patients underwent OHT during the study period. Median age was 56 years, 22 (26.2%) females, and 29 (34.5%) ischemic etiology. Eighteen (21.4%) patients developed VS after OHT. VS was associated with a higher median BMI (31.0 vs 27.3; p = 0.01) as compared to patients absent VS. Median duration of CF-LVAD support was longer in VS patients; 13.4 months vs 9.2 months, p=0.27. In 69 HMII patients, the mean PI at admission was lower in those who subsequently developed VS; 5.9 vs 6.4; p= 0.04. The rest of the recipient, donor and intraoperative characteristics were similar between groups. Multivariate logistic regression analysis revealed BMI (OR 1.34; 95% CI 1.11-1.63; p Conclusion VS after transplant in CF LVAD subjects is associated with low pulsatility and high BMI. In this single center experience, VS was not associated with worse outcomes.