Vasoplegic Syndrome during Left Ventricular Assist Device Insertion: A Systematic Review and Meta-Analysis.
Nicolas Kumar, Jamel P Ortoleva, Michael G Fitzsimons et al.
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In 30 seconds
This systematic review and meta-analysis combined 16 retrospective studies of adults undergoing durable left ventricular assist device insertion, covering 3,121 insertions and 1,093 vasoplegic syndrome (VS) cases. The pooled incidence of VS was 36.30% (95% CI: 34.61%-38.02%). VS was associated with higher postoperative morbidity, including right ventricular failure and renal replacement therapy, and with higher mortality: 30-day mortality was 14.85% v 5.63%, and 1-year mortality was 33.88% v 22.62%.
Key findings
- Pooled VS incidence after durable LVAD insertion was 36.30% (95% CI: 34.61%-38.02%).
- Associated risk factors included male sex (RR 1.65, p = 0.008), INTERMACS profile ≤2 (RR 1.19, p = 0.009), and repeat sternotomy (RR 1.30, p = 0.020).
- VS was associated with right ventricular failure (OR 1.76, p < 0.001) and renal replacement therapy (OR 1.77, p < 0.001).
- Mortality was higher with VS at 30 days (14.85% v 5.63%, p < 0.001) and 1 year (33.88% v 22.62%, p = 0.030).
Why it matters
VS affected approximately one-third of LVAD recipients in the pooled studies and was associated with important postoperative complications and higher mortality. The reported associations identify perioperative features that may help clinicians recognise patients at increased risk and frame discussions about expected outcomes, while not establishing that VS itself causes these outcomes.
What to keep in mind
The evidence came from retrospective studies, so the reported risk factors and outcome differences are associations and may be affected by confounding.