VASOPLEGIC SYNDROME AFTER OPEN-HEART-SURGERY

Background. A new form of postperfusion manifestation is detailed, a v asoplegic syndrome presenting in the postoperative period after cardio pulmonary bypass (CPB) heart surgery. Methods. This retrospective stud y included sixteen patients who underwent cardiovascular surgery using CPB acid exhibited clinical and hemodynamic features compatible with vasoplegic syndrome. The technique of CPB was hypothermic (28 degrees C) in 15 and normothermic in 1 patient, and hypothermic blood cardiopl egia was employed in all patients, except 1, The mean CPB time was 121 minutes, ranging from 80 to 210 minutes. Results. The patients presen ted a severe feature comprising hypotension, tachycardia, normal or el evated cardiac output, low systemic vascular resistance and decreased filling pressures. Fluid administration alone was not capable of resto ring hemodynamic parameters. Physical examination revealed normal capi llary filling at the extremities although oliguria and hypotension wer e observed. These patients needed a high dosage of vasoconstrictor dru gs (norepinephrine) for blood pressure control but even high dose nore pinephrine did clot produce the classical situation of cool extremitie s and weak peripheral pulses, with increased morbidity and mortality. Severe systemic complications could develop if the vasoplegic syndrome persisted 36-48 hours after its onset. All patients, except 3, presen ted associated postoperative complications and 4 patients died. The ch aracteristics of vasoplegic syndrome are similar to those observed in septic shock, where the alterations are mediated by cytokines and tumo r necrosis factor-alpha. Conclusions. The appearance of vasoplegic syn drome augmented operative morbidity with a consequent increased risk t o the patient in the early postoperative period.