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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1446861

Independent factors for the development of vasoplegic syndrome in patients undergoing coronary artery bypass surgery

Provisionally accepted
Constantin L. Palm Constantin L. Palm 1,2Lukas Baumhove Lukas Baumhove 2Simon Pabst Simon Pabst 1Ulf Guenther Ulf Guenther 3*Malte Book Malte Book 3*Onise Chaduneli Onise Chaduneli 4*Andreas Martens Andreas Martens 1*Friedrich Mellert Friedrich Mellert 4*Oliver Dewald Oliver Dewald 4*
  • 1 Department of Cardiac Surgery, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany, Oldenburg, Germany
  • 2 Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, Groningen, Germany
  • 3 Department of Anesthesiology, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany, Oldenburg, Germany
  • 4 Department of Cardiac Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany

The final, formatted version of the article will be published soon.

    Objective: Vasoplegic syndrome remains a common complication of cardiac surgery. It has serious implications for the healthcare system and individual patients, as it leads to rising healthcare costs and higher mortality. A better understanding of factors triggering vasoplegic syndrome is essential for the development of effective prevention strategies. We aimed to identify clinical characteristics and intraoperative parameters associated with the development of vasoplegic syndrome in coronary artery bypass graft surgery and the influence of vasoplegia on outcome.Methods: We retrospectively analyzed the data of all patients who underwent isolated coronary artery bypass graft surgery or coronary artery bypass graft surgery combined with atrial appendage occlusion, using the heart-lung machine at our institution from 04/2019 to 12/2020. Vasoplegic syndrome was defined as MAP ≤60 mmHg and norepinephrine equivalence dosage of ≥ 0.2ug/kg/min with a central venous saturation ≥60% within two days from surgery. Results: Of 647 patients included in this study, 72 (11.1 %) developed vasoplegic syndrome.Patients experiencing vasoplegia had longer stay in ICU, more frequently underwent tracheostomy and suffered more often from pneumonia. The duration of extracorporeal circulation, intraoperative application of platelet concentrates and usage of cold crystalloid cardioplegia (Bretschneider) independently predicted development of vasoplegic syndrome.Conclusions: Even in relatively low-risk cardiac surgery, vasoplegic syndrome is a common complication and was associated with serious adverse effects. The use of warm blood cardioplegia (Calafiore) seems to be safer than cold crystalloid cardioplegia (Bretschneider) and might be preferable in patients that are vulnerable to the consequences of vasoplegic syndrome.

    Keywords: Vasoplegic syndrome, Coronary artery bypass graft surgery, Bretschneider cardioplegia, Warm blood cardioplegia, extracorporeal circulation (ECC)

    Received: 10 Jun 2024; Accepted: 28 Aug 2024.

    Copyright: © 2024 Palm, Baumhove, Pabst, Guenther, Book, Chaduneli, Martens, Mellert and Dewald. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Ulf Guenther, Department of Anesthesiology, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany, Oldenburg, Germany
    Malte Book, Department of Anesthesiology, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany, Oldenburg, Germany
    Onise Chaduneli, Department of Cardiac Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
    Andreas Martens, Department of Cardiac Surgery, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany, Oldenburg, Germany
    Friedrich Mellert, Department of Cardiac Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
    Oliver Dewald, Department of Cardiac Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany

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