Pre-operative Risk Factors and Clinical Outcomes Associated with Vasoplegia in Recipients of Orthotopic Heart Transplantation in the Contemporary Era.
Writer and Curator: Larry H. Bernstein, MD, FCAP
and
Curator: Aviva Lev-Ari, PhD, RN
- associated with high mortality and morbidity.
- low systemic vascular resistance ( SVR index <1,600 dyn∙seg/cm5/m2 ) and
- high cardiac output ( cardiac index >2.5 l/min/m2 )
- within the first 4 postoperative hours.
Methylene blue and vasoplegia: who, when, and how?
- dysregulation of endothelial homeostasis and subsequent endothelial dysfunction
- secondary to direct and indirect effects of multiple inflammatory mediators.
- an inhibitor of nitric oxide synthase (NOS) and guanylate cyclase (GC),
- the refractory hypotension associated with endothelial dysfunction of VS.
- persistent low systemic vascular resistance,
- despite multiple intravenous pressor drugs at high dose,
- between 6 and 48 hours after surgery.
- a higher body surface area (1.8 ± 0.25 vs 1.63 ± 0.36, p = 0.0007),
- greater history of thyroid disease (38.2% vs 18.5%, p = 0.0075) and
- a higher rate of previous cardiothoracic surgery (79% vs 48%, p = 0.0006).
- they were more frequently treated with aspirin (73% vs 48%, p = 0.005) and
- mechanical assist devices (ventricular assist devices [VADs]: 45% vs 17%, p < 0.0001;
- total artificial hearts: 8.6% vs 0%, p < 0.0001), and
- less treated with milrinone (14.7% vs 45.8%, p = 0.0005).
- higher mortality (3.2% vs 17.1%, p = 0.0003) and morbidity in the first 30 days after transplant.
- were independent risk factors for development of vasoplegia syndrome.
- High body mass index,
- long cardiopulmonary bypass time,
- prior cardiothoracic surgery,
- mechanical support,
- use of aspirin, and
- thyroid disease
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Space-filling model of the cyclic guanosine monophosphate molecule, also known as cGMP, a nucleotide. This image shows the anionic (negatively charged) form. Colour code (click to show) : Black: Carbon, C : White: Hydrogen, H : Red: Oxygen, O : Blue: Nitrogen, N : Orange: Phosphorus, P (Photo credit: Wikipedia)
Ball-and-stick model of the cyclic guanosine monophosphate molecule, also known as cGMP, a nucleotide. This image shows the anionic (negatively charged) form. Colour code (click to show) : Black: Carbon, C : White: Hydrogen, H : Red: Oxygen, O : Blue: Nitrogen, N : Orange: Phosphorus, P (Photo credit: Wikipedia)
English: Drawing showing targets of cGMP in cells (Photo credit: Wikipedia)
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