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Vasoplegia in the Postoperative Period After Cardiac Transplantation

  • Joshua L. Chan
  • Fardad EsmailianEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Vasoplegia syndrome is a distinct pathologic process that occurs following cardiac surgery. The use of cardiopulmonary bypass and the propagation of circulating inflammatory cytokines is believed to be a key mediator in the development of this vasodilatory shock. Heart transplantation is a known risk factor for vasoplegia, and remains a relevant concern in a vulnerable population particularly susceptible to the morbidity related to severe hemodynamic aberrations. The treatment of this complex phenomenon following cardiac transplantation can be challenging, as it is often refractory to conventional critical care. Additional strategies have been evaluated in the management of vasoplegia syndrome. Multiple trials have identified low dose arginine vasopressin infusion (0.03 U/min) as a useful treatment option in mitigating this global vasodilatory state, with a growing number of studies indicating its efficacy as a prophylactic agent as well. Investigation of methylene blue (2 mg/kg) has also demonstrated encouraging results when employed in similar circumstances. Based on the cumulative results of available studies, the use of arginine vasopressin or methylene blue is recommended in heart transplant patients without contraindications to therapy who exhibit vasoplegia syndrome refractory to conventional management techniques. In patients with multiple preoperative risk factors for vasoplegia, arginine vasopressin or methylene blue may additionally be considered as a prophylactic pharmacologic option.

Keywords

Vasoplegia, low systemic vascular resistance syndrome Arginine vasopressin Methylene blue Cardiac transplantation 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Cedars-Sinai Heart InstituteLos AngelesUSA

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