Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function.
BACKGROUND
Although vasodilatory shock (VS) is one of the main complications of cardiopulmonary bypass (CPB), its pathophysiologic basis remains unclear. The aim of this study was to identify predisposing factors for the development of VS after CPB independent of ventricular function.


METHODS
Thirty-six patients undergoing coronary artery bypass grafting who developed VS were compared with 72 control patients without post-CPB cardiogenic or vasoplegic shock, in a 2:1 case control study. Patients and controls underwent the same anesthetic protocol and were matched by age, sex, operation date, and left ventricle ejection fraction.


RESULTS
Preoperative and intraoperative patient characteristics were not significantly different between the two groups. Preoperative use of angiotensin-converting enzyme inhibitors and intravenous heparin were independent predictors for post-CPB VS by multivariate analysis (relative risk of 2.26 and 2.78, respectively). Intensive care unit stay and hospital stay were significantly longer in VS cases than controls, without any difference in early postoperative mortality.


CONCLUSIONS
The only independent risk factors for postoperative VS identified were preoperative use of angiotensin-converting enzyme inhibitors and intravenous heparin. These risk factors were independent of age, gender, anesthetic protocol, and left ventricle ejection fraction.
Mekontso-Dessap
A
A
Service de Chirurgie Thoracique et Cardiovasculaire, CNRS UPRES-A 7053, Centre Hospitalo-Universitaire Henri Mondor, Créteil, France.
Houël
R
R
Soustelle
C
C
Kirsch
M
M
Thébert
D
D
Loisance
D Y
DY
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011292:Premedication; D012307:Risk Factors; D012769:Shock / Q000503:physiopathology*; D013318:Stroke Volume / Q000502:physiology; D014664:Vasodilation / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
D000806:Angiotensin-Converting Enzyme Inhibitors; D006493:Heparin