Severe aortic-radial pressure gradient and vasoplegic shock syndrome after cardiopulmonary bypass: A case report and literature review

Vasoplegic shock syndrome (VS) occurs in up to 20% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and is associated with increased morbidity rates and poor prognosis. Here, we report a case of severe refractory VS with high aortic-radial pressure gradient following cardiac surgery. A 46-year-old female underwent metal mitral valve replacement, tricuspid valve plasty, and left atrial thrombectomy exhibited refractory peripheral hypotension during rewarming on CPB. Central aortic pressure measurement revealed a significant aortic-radial pressure gradient. By increasing perfusion flow and the administration of vasoactive medications, the aortic pressure gradually normalized but VS still existed, and then weaning from CPB under the guidance of transesophageal echocardiography (TEE). After the patient was transferred to the cardiac intensive care unit (CICU), pulse indicator continuous cardiac output (PICCO) was implanted to guide the maintenance of cardiac function, volume expansion and stable hemodynamics, and the dosage of vasoactive medications was gradually reduced. The patient was discharged on postoperative day 10. A significant aortic-radial pressure gradient was considered an early sign of VS. Early recognition, combined with advanced hemodynamic monitoring and assessment of oxygen metabolism indicators, is crucial for optimizing perioperative management and improving outcomes in patients undergoing CPB.