Ara Klijian1, Ashish K Khanna2, V Seenu Reddy3, Bruce Friedman4, Jamel Ortoleva5, Adam S Evans6, Rakshit Panwar7, Stew Kroll8, Charles R Greenfeld8, Subhasis Chatterjee9. 1. Department of Cardiothoracic Surgery, Sharp and Scripps Healthcare, San Diego, CA. 2. Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC; Outcomes Research Consortium, Cleveland, OH. 3. TriStar Cardiovascular Surgery, Nashville, TN. 4. JM Still Burn Center, Doctor's Hospital, Augusta, GA. 5. Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA. 6. ASE Consulting, LLC, Tenafly, NJ. 7. John Hunter Hospital, Newcastle, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 8. La Jolla Pharmaceutical Company, San Diego, CA. 9. Divisions of General and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX. Electronic address: Subhasis.Chatterjee@bcm.edu.
Abstract
OBJECTIVE: The present study investigated outcomes in patients with vasoplegia after cardiac surgery treated with angiotensin II plus standard-of-care vasopressors. Vasoplegia is a common complication in cardiac surgery with cardiopulmonary bypass and is associated with significant morbidity and mortality. Approximately 250,000 cardiac surgeries with cardiopulmonary bypass are performed in the United States annually, with vasoplegia occurring in 20%to-27% of patients. DESIGN: Post-hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. SETTING: Multicenter, multinational study. PARTICIPANTS: Sixteen patients with vasoplegia after cardiac surgery with cardiopulmonary bypass were enrolled. INTERVENTIONS: Angiotensin II plus standard-of-care vasopressors (n = 9) compared with placebo plus standard-of-care vasopressors (n = 7). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was mean arterial pressure response (mean arterial pressure ≥75 mmHg or an increase from baseline of ≥10 mmHg at hour 3 without an increase in the dose of standard-of-care vasopressors). Vasopressor sparing and safety also were assessed. Mean arterial pressure response was achieved in 8 (88.9%) patients in the angiotensin II group compared with 0 (0%) patients in the placebo group (p = 0.0021). At hour 12, the median standard-of-care vasopressor dose had decreased from baseline by 76.5% in the angiotensin II group compared with an increase of 7.8% in the placebo group (p = 0.0013). No venous or arterial thrombotic events were reported. CONCLUSION: Patients with vasoplegia after cardiac surgery with cardiopulmonary bypass rapidly responded to angiotensin II, permitting significant vasopressor sparing.
OBJECTIVE: The present study investigated outcomes in patients with vasoplegia after cardiac surgery treated with angiotensin II plus standard-of-care vasopressors. Vasoplegia is a common complication in cardiac surgery with cardiopulmonary bypass and is associated with significant morbidity and mortality. Approximately 250,000 cardiac surgeries with cardiopulmonary bypass are performed in the United States annually, with vasoplegia occurring in 20%to-27% of patients. DESIGN: Post-hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. SETTING: Multicenter, multinational study. PARTICIPANTS: Sixteen patients with vasoplegia after cardiac surgery with cardiopulmonary bypass were enrolled. INTERVENTIONS: Angiotensin II plus standard-of-care vasopressors (n = 9) compared with placebo plus standard-of-care vasopressors (n = 7). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was mean arterial pressure response (mean arterial pressure ≥75 mmHg or an increase from baseline of ≥10 mmHg at hour 3 without an increase in the dose of standard-of-care vasopressors). Vasopressor sparing and safety also were assessed. Mean arterial pressure response was achieved in 8 (88.9%) patients in the angiotensin II group compared with 0 (0%) patients in the placebo group (p = 0.0021). At hour 12, the median standard-of-care vasopressor dose had decreased from baseline by 76.5% in the angiotensin II group compared with an increase of 7.8% in the placebo group (p = 0.0013). No venous or arterial thrombotic events were reported. CONCLUSION: Patients with vasoplegia after cardiac surgery with cardiopulmonary bypass rapidly responded to angiotensin II, permitting significant vasopressor sparing.
Authors: Caitlin C Ten Lohuis; Sarah C Burke; Cooper J Jannuzzo; Nicholas A Barker; Edward P Chen; Laurence W Busse Journal: Crit Care Explor Date: 2022-05-13
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Authors: Subhasis Chatterjee; Ourania Preventza; Mariam C Mousavi; Vicente Orozco-Sevilla; Scott A LeMaire; Joseph S Coselli Journal: JTCVS Tech Date: 2020-08-15