14. VASOPLEGIA AND THE EFFECT OF NORADRENALINE IN CARDIOVASCULAR SURGERY WITH CARDIOPULMONARY BYPASS
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Abstract
Objective: Evaluate the incidence, risk factors, and the effectiveness of Noradrenaline treatment in vasoplegia during cardiac surgery with cardiopulmonary bypass.
Subjects and methods: This prospective cross-sectional study was conducted on 70 patients undergoing scheduled cardiac surgery with cardiopulmonary bypass at Hanoi Heart Hospital from March 2025 to July 2025. Patients were evaluated for vasoplegia status, demographic characteristics, echocardiographic, surgical-related factors, and postoperative outcomes. The vasoplegia and non-vasoplegia groups were compared using appropriate statistical tests to identify associated factors.
Results: Vasoplegia occurred in 14 patients (20%). There were no statistically significant differences between the two groups in terms of age, gender, body mass index, left ventricular ejection fraction, left ventricular diastolic diameter index, NYHA classification, or ASA physical status. However, anesthesia duration, operative time, aortic cross - clamp time, and cardiopulmonary bypass duration were significantly longer in the vasoplegia group (p < 0.05). Vasoplegia was also associated with the use of custodiol cardioplegia and more complex procedures such as aortic replacement or combined surgeries. The average total dose of intraoperative Noradrenaline was 403.79 ± 202.95 mcg, with an average duration of 95 ± 49.87 minutes. The mean intraoperative infusion rate was 0.08 ± 0.03 mcg/kg/min, and at the end of surgery, it decreased to 0.06 ± 0.04 mcg/kg/min. Patients with vasoplegia had significantly longer durations of mechanical ventilation and ICU stay, as well as higher postoperative blood lactate levels (4.27 ± 1.74 mmol/L vs. 2.96 ± 1.35 mmol/L in the non-vasoplegia group).
Conclusion: Patients undergoing complex cardiac surgeries with prolonged operative time, cardiopulmonary bypass duration, and aortic cross - clamp time are at higher risk of developing vasoplegia. Noradrenaline is effective in treating vasoplegia; however, patients with this condition tend to require longer mechanical ventilation and ICU care. Microcirculatory perfusion disturbances may still occur even in patients without vasoplegia.
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References
[2] Fischer G.W, Levin M.A. Vasoplegia during cardiac surgery: current concepts and management. Seminars in Thoracic and Cardiovascular Surgery, 2010, 22 (2), 140-4.
[3] Levy B, Fritz C, Tahon E et al. Vasoplegia treatments: the past, the present, and the future. Critical care, 2018, 22, 1-11.
[4] Omar S, Zedan A, Nugent K. Cardiac vasoplegia syndrome: pathophysiology, risk factors and treatment. The American journal of the medical sciences, 2015, 349 (1), 80-88.
[5] Bastopcu M, Sargın M, Kuplay H et al. Risk factors for vasoplegia after coronary artery bypass and valve surgery. Journal of Cardiac Surgery, 2021, 36 (8), 2729-2734.
[6] Levin M.A, Lin H.M, Castillo J.G et al. Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome. Circulation, 2009, 120 (17), 1664-71.
[7] Abou-Arab O, Kamel S, Beyls C et al. Vasoplegia after cardiac surgery is associated with endothelial glycocalyx alterations. Journal of Cardiothoracic Vascular Anesthesia, 2020, 34 (4), 900-905.
[8] Dayan V, Cal R, Giangrossi F. Risk factors for vasoplegia after cardiac surgery: a meta-analysis. Interactive CardioVascular and Thoracic Surgery, 2019, 28 (6), 838-844.