(137) Outcomes and Risk Factors in Vasoplegic Patients Following LVAD Implantation

Introduction: Risk factors for vasoplegia have been described in general cardiac surgery cases, but there are minimal data describing risk factors for vasoplegia following left ventricular assist device (LVAD) implantation. The goal of this analysis was to describe vasoplegia incidence and factors associated with vasoplegia in an LVAD patient population.

Methods: This was a retrospective analysis of adult patients who underwent LVAD implantation at Cleveland Clinic between 2019 and 2022. Patients who had post-operative cardiogenic shock or hemorrhagic shock were excluded. The primary outcome was the incidence of vasoplegia (persistent hypotension requiring >0.2 mcg/kg/min norepinephrine-equivalent [NEE] for >6 hours) following LVAD implantation. Multivariable logistic regression analysis was conducted to determine factors associated with the development of vasoplegia after adjustment for age, duration of cardiopulmonary bypass (CPB), preoperative inotrope prior to LVAD implantation, INTERMACS classification, preoperative MAP, preoperative renin-angiotensin-aldosterone (RAAS) inhibitor and beta blocker use, and eGFR < 30 mL/min/1.73m2. A subgroup analysis was performed to compare patients who received and did not receive preoperative RAAS inhibitors to evaluate their impact on post-operative vasoplegia.

Results: A total of 250 patients were evaluated, with 186 patients included in the final analysis. Pre-operative inotropes were used in 85 (46%) of patients, with similar use of milrinone (43, 23%) and dobutamine (41, 22%). The incidence of vasoplegia was 34%. In patients who developed vasoplegia, the median maximum dose of vasopressors was 0.28 mcg/kg/min (0.24-0.35) NEE. A greater percentage of patients who experienced vasoplegia had preoperative renal dysfunction. A longer duration of CPB (OR 1.014) was the only factor independently associated with increased risk of vasoplegia. No differences in rates of vasoplegia were observed based on receipt of preoperative RAAS inhibitors. No mortality differences were observed between patients who did versus did not develop vasoplegia.

Conclusions: Vasoplegia following LVAD implantation is a common postoperative complication. Longer duration of CPB during LVAD implantation was associated with an increased risk of developing postoperative vasoplegia.