Vasoplegia in Patients Undergoing Heart Transplantation Bridged with an LVAD is Not Associated with Inferior Long-Term Outcomes

Purpose Vasoplegia has been associated with inferior outcomes following heart transplantation (HTx). This observational study was designed to investigate outcomes in recipients with vasoplegia following LVAD explant and heart transplantation. Methods All patients undergoing LVAD explant followed by HTx from 01/2013 - 10/2018 at our centre were included. Vasoplegia was defined as the requirement for high dose vasopressor (noradrenaline [>0.5 μg/kg/min] and vasopressin [>1U/hr]) over the first 24 hours following HTx. Demographic and outcome data were retrieved from the transplant unit database. Results During the study period 22 patients underwent LVAD explant and HTx. Of these, 12 (54.4%) developed vasoplegia. There were no differences in donor and recipient demographics. Both groups had a similar duration of LVAD support (median 651 vs 709 days p=0.70). HTx following donation after circulatory death (DCD) occurred in 7 (31.8%) patients and was not associated with a higher incidence of vasoplegia (p=0.23). Patients developing vasoplegia had a longer warm ischaemia time (51 vs 36 min p=0.04) and required higher amounts of metaraminol intraoperatively (p=0.02). Median follow-up is 424 days. Outcomes are summarised in Table 1. Patients developing vasoplegia had similar ICU (p=0.87) and hospital (p=0.64) lengths of stay. There has been no association with episodes of acute rejection (p=1). Survival was equivalent both at 30-day (91.7% vs 100% p=1) and 1-year (72.9% vs 72% p=0.75). Our overall HTx 1-year survival was 89% over this period. Conclusion This study demonstrates that LVAD explant confers a survival disadvantage. However, development of vasoplegia following HTx in patients bridged with an LVAD is not associated with inferior outcomes. If patients are appropriately managed, the impact of vasoplegia can be minimised and outcomes not compromised.