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Difficult Decisions in Cardiothoracic Critical Care Surgery pp 315–329Cite as

Vasoplegia in the Postoperative Period After Cardiac Transplantation

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((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.

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Authors and Affiliations

  1. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Joshua L. Chan & Fardad Esmailian

  2. Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Fardad Esmailian

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  1. Joshua L. Chan
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  2. Fardad Esmailian
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Correspondence to Fardad Esmailian .

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Editors and Affiliations

  1. University of Chicago Medicine, Chicago, IL, USA

    Vassyl A. Lonchyna

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Chan, J.L., Esmailian, F. (2019). Vasoplegia in the Postoperative Period After Cardiac Transplantation. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_23

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  • DOI: https://doi.org/10.1007/978-3-030-04146-5_23

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-04146-5

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