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Vasoplegic Syndrome After Cardiovascular Surgery: A Review of Pathophysiology and Outcome Oriented Therapeutic Management
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  • Vishnu Datt,
  • Rachna Wadhwa,
  • Varun Sharma,
  • Sanjula Virmani,
  • Harpreet Minhas,
  • Shardha Malik
Vishnu Datt
GB Pant Hospital
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Rachna Wadhwa
GB Pant Hospital
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Varun Sharma
GB Pant Hospital
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Sanjula Virmani
G B Pant Hospital
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Harpreet Minhas
GB Pant Hospital
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Shardha Malik
GB Pant Hospital
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Abstract

Vasoplegic syndrome (VPS) is defined as systemic hypotension due to profound vasodilatation and loss of systemic vascular resistance (SVR), despite normal or increased cardiac index (CI). It occurs in 9- 44% of cardiac surgery patients after cardiopulmonary bypass (CPB) and is associated with significant morbidity and mortality. The pathogenesis of VPS is multifactorial involving the activation of contact, coagulation, and complement systems and the activation of leukocytes. platelets and endothelial cells resulting in an imbalance in the regulation of the vascular tone; inducible nitric oxide synthase [iNOS] triggered by inflammatory cytokines during CPB produces nitric oxide (NO), which increases vascular levels of cyclic guanosine monophosphate (cGMP), resulting in vasodilation. leading to postcardiac surgery VPS. Standard treatment options for severe refractory VPS are extremely limited and include vasopressor support. latest Surviving Sepsis Campaign guidelines also consider that the best therapeutic management of vascular hypo- responsiveness to vasopressors could be a combination of multiple vasopressors, including norepinephrine (NE) and early prescription of vasopressin. This review will address the various definitions, risk factors, pathophysiology, potential cardiac candidates, and potential therapeutic interventions for VPS following cardiac surgery focussed on the outcome. This review did not require any ethical approval or consent from the patients.

Peer review status:UNDER REVIEW

04 Jun 2021Submitted to Journal of Cardiac Surgery
05 Jun 2021Assigned to Editor
05 Jun 2021Submission Checks Completed
05 Jun 2021Reviewer(s) Assigned