Risk Stratification of Postoperative Vasoplegia After Cardiac Surgery

Vasoplegic syndrome is a common and potentially life-threatening complication following cardiac surgery with cardiopulmonary bypass. It is characterized by profound hypotension due to persistently reduced systemic vascular resistance despite preserved or increased cardiac output. The reported incidence ranges from 8% to 44%, and severe, catecholamine-resistant forms are associated with markedly increased mortality. In this retrospective study, 3937 cardiac surgical patients treated at the University Hospital Frankfurt between 2017 and 2021 were analyzed. Postoperative vasoplegic syndrome occurred in 17.5% of the cases and was classified as mild to moderate or severe according to vasopressor requirements. Preoperative, intraoperative, and postoperative variables were assessed using descriptive statistics as well as univariate and multivariable regression analyses to identify independent risk factors. Advanced age, elevated body mass index, EuroSCORE II > 10%, arterial degenerative diseases, preoperative dialysis dependence, atrioventricular valve surgery, emergency procedures, prolonged cardiopulmonary bypass and operative times, blood loss or transfusion and elevated preoperative hematocrit were identified as independent risk factors. Postoperatively, impaired renal function, increased inflammatory markers, and low hemoglobin levels were associated with vasoplegic syndrome. Severe vasoplegic syndrome was associated with increased mortality, prolonged intensive care unit stay, and extended hospitalization. Further research is required to establish standardized definitions and optimize prevention and treatment strategies.