Vasoplegic syndrome after pediatric cardiac surgery

Abstract

Vasoplegic syndrome (VS) is a form of vasodilatory shock that occurs in the early period in patients who undergo cardiac surgery requiring cardiopulmonary bypass (CBP). Vasoplegic syndrome, reported between 9 and 44%, is characterized by severe hypotension,severe decrease in systemic vascular resistance, decreased arteriolar reactivity, need for increased volume, and decreased response to norepinephrine, despite normal cardiac outflow.1,2 Vasoplegia is associated with high mortality and morbidity, especially in pediatric patients. Prolonged use of ACE inhibitor, calcium channel blockers, use of amiodarone and heparin, low cardiac reserve (EF <35%), symptomatic congestive heart failure and diabetes mellitus are among perioperative risk factors in adults.3 On the other hand, preand post-CPB hematocrit, pre-bypass mean arterial pressure (MAP), surgery type, duration of bypass, use of antifibrinolytic and/or vasopressor before bypass, hypothermia and needed dose of vasopressin for terminating bypass have been found intraoperative risk factors in pediatric cases.4