Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis - Université Paris-Est-Créteil-Val-de-Marne Access content directly
Journal Articles Journal of Clinical Medicine Year : 2022

Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis

Pascal Lim
  • Function : Author
Margaux Le Maistre
  • Function : Author
Lucas Benoudiba Campanini
  • Function : Author
Quentin de Roux
Nicolas Mongardon
Valentin Landon
  • Function : Author
Hassina Bouguerra
  • Function : Author
David Aouate
  • Function : Author
Paul-Louis Woerther
Fihman Vincent
Adrien Galy
  • Function : Author
Vania Tacher
  • Function : Author
Sébastien Galien
  • Function : Author
Pierre-Vladimir Ennezat
Antonio Fiore
Thierry Folliguet
Raphaelle Huguet
Armand Mekontso-Dessap
Bernard Iung
  • Function : Author
Raphael Lepeule
  • Function : Author

Abstract

Purpose: Post-operative vasoplegic syndrome is a dreaded complication in infective endocarditis (IE). Methods and Results: This retrospective study included 166 consecutive patients referred to cardiac surgery for non-shocked IE. Post-operative vasoplegic syndrome was defined as a persistent hypotension (mean blood pressure < 65 mmHg) refractory to fluid loading and cardiac output restoration. Cardiac surgery was performed 7 (5–12) days after the beginning of antibiotic treatment, 4 (1–9) days after negative blood culture and in 72.3% patients with adapted anti-biotherapy. Timing of cardiac surgery was based on ESC guidelines and operating room availability. Most patients required valve replacement (80%) and cardiopulmonary bypass (CPB) duration was 106 (95–184) min. Multivalvular surgery was performed in 43 patients, 32 had tricuspid valve surgery. Post-operative vasoplegic syndrome was reported in 53/166 patients (31.9%, 95% confidence interval of 24.8–39.0%) of the whole population; only 15.1% (n = 8) of vasoplegic patients had a post-operative documented infection (6 positive blood cultures) and no difference was reported between vasoplegic and non-vasoplegic patients for valve culture and the timing of cardiac surgery. Of the 23 (13.8%) in hospital-deaths, 87.0% (n = 20) occurred in the vasoplegic group and the main causes of death were multiorgan failure (n = 17) and neurological complications (n = 3). Variables independently associated with vasoplegic syndrome were CPB duration (1.82 (1.16–2.88) per tertile) and NTproBNP level (2.11 (1.35–3.30) per tertile). Conclusions: Post-operative vasoplegic syndrome is frequent and is the main cause of death after IE cardiac surgery. Our data suggested that the mechanism of vasoplegic syndrome was more related to inflammatory cardiovascular injury rather than the consequence of ongoing bacteremia.

Dates and versions

hal-04298082 , version 1 (21-11-2023)

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Pascal Lim, Margaux Le Maistre, Lucas Benoudiba Campanini, Quentin de Roux, Nicolas Mongardon, et al.. Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis. Journal of Clinical Medicine, 2022, 11 (19), pp.5523. ⟨10.3390/jcm11195523⟩. ⟨hal-04298082⟩
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