Vasoplegic syndrome after open heart surgery

Vasoplegic syndrome after open heart surgery

Author Gomes, Walter José Autor UNIFESP Google Scholar
Carvalho, A. C. Autor UNIFESP Google Scholar
Palma, J. H. Autor UNIFESP Google Scholar
Teles, Carlos Alberto Autor UNIFESP Google Scholar
Branco, João Nelson Rodrigues Autor UNIFESP Google Scholar
Silas, Marcelo Grandini Autor UNIFESP Google Scholar
Buffolo, Enio Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Background. A new form of postperfusion manifestation is detailed, a vasoplegic syndrome presenting in the postoperative period after cardiopulmonary bypass (CPB) heart surgery.Methods. This retrospective study included sixteen patients who underwent cardiovascular surgery using CPB acid exhibited clinical and hemodynamic features compatible with vasoplegic syndrome. The technique of CPB was hypothermic (28 degrees C) in 15 and normothermic in 1 patient, and hypothermic blood cardioplegia was employed in all patients, except 1, The mean CPB time was 121 minutes, ranging from 80 to 210 minutes.Results. The patients presented a severe feature comprising hypotension, tachycardia, normal or elevated cardiac output, low systemic vascular resistance and decreased filling pressures. Fluid administration alone was not capable of restoring hemodynamic parameters. Physical examination revealed normal capillary filling at the extremities although oliguria and hypotension were observed. These patients needed a high dosage of vasoconstrictor drugs (norepinephrine) for blood pressure control but even high dose norepinephrine did clot produce the classical situation of cool extremities and weak peripheral pulses, with increased morbidity and mortality. Severe systemic complications could develop if the vasoplegic syndrome persisted 36-48 hours after its onset. All patients, except 3, presented associated postoperative complications and 4 patients died. The characteristics of vasoplegic syndrome are similar to those observed in septic shock, where the alterations are mediated by cytokines and tumor necrosis factor-alpha.Conclusions. The appearance of vasoplegic syndrome augmented operative morbidity with a consequent increased risk to the patient in the early postoperative period.
Keywords heart surgery
cardiopulmonary bypass
cytokines
Language English
Date 1998-10-01
Published in Journal Of Cardiovascular Surgery. Turin: Edizioni Minerva Medica, v. 39, n. 5, p. 619-623, 1998.
ISSN 0021-9509 (Sherpa/Romeo, impact factor)
Publisher Edizioni Minerva Medica
Extent 619-623
Origin https://www.minervamedica.it/en/journals/cardiovascular-surgery/article.php?cod=R37Y1998N05A0619
Access rights Closed access
Type Article
Web of Science ID WOS:000077016900017
URI http://repositorio.unifesp.br/11600/44223

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