Incidence, Predictors and Outcome of Vasoplegia After Left Ventricular Assist Device Implantation

Background: Vasoplegia after heart failure surgery has been associated with increased morbidity and mortality. The aim of this study was to evaluate the incidence and impact of postoperative vasoplegia in patients undergoing durable continuous flow left ventricular assist device implantation (cfLVAD). Methods: All patients who underwent cfLVAD implantation were included in this analysis. Vasoplegia was defined as the need for norepinephrine ≥0.2 μg/kgBW/min and/or any vasopressin dose for ≥12 h starting within 72 h postoperatively without bleeding/pericardial tamponade requiring surgical revision. Endpoints included the incidence of vasoplegia and 30- and 90-day mortality. Cox proportional hazard model was used to assess the association between vasoplegia and mortality. Multivariate logistic regression analysis was performed to identify predictors of vasoplegia. Results: Between 08/2010 and 12/2023, 307 consecutive patients underwent durable cfLVAD implantation. Mean age was 58 ± 11 years. Of the patients, 94% were operated with cardiopulmonary bypass and in 71% intraoperative hemoadsorption was applied. The incidence of vasoplegia was 23%. Vasoplegia was significantly associated with increased short-term mortality compared to non-vasoplegic patients (HR: CI: p < 0.001). Multivariate regression analysis identified preoperative invasive ventilation and preoperative vasopressor support as strong risk factors for postoperative vasoplegia, while intraoperative hemoadsorption reduced this risk. Conclusion: Vasoplegia after durable cfLVAD implantation is a common and serious complication associated with increased short-term mortality. Preoperative mechanical ventilation and vasopressor support are risk factors for developing postoperative vasoplegia. Intraoperative hemoadsorption appears to reduce the risk of vasoplegia after durable cfLVAD implantation.