Key result
Post-bypass vasoplegic syndrome is linked to ~6.2-fold higher in-hospital mortality.
Why the study?
Vasoplegic syndrome is a life-threatening form of distributive shock following cardiopulmonary bypass, yet data on its prevalence, clinical characteristics, and predictors in Latin American populations remain scarce.
What are the prevalence, clinical predictors, and associated in-hospital outcomes of vasoplegic syndrome in adults undergoing cardiac surgery with cardiopulmonary bypass in a Mexican cohort?
Cohort (n=788)
No
What are the prevalence, clinical predictors, and associated in-hospital outcomes of vasoplegic syndrome in adults undergoing cardiac surgery with cardiopulmonary bypass in a Mexican cohort?
In a contemporary Mexican cardiac surgery cohort, vasoplegic syndrome occurred in 7.48% of patients following cardiopulmonary bypass and conferred over a six-fold increase in the odds of in-hospital mortality and need for renal replacement therapy.
Background Vasoplegic syndrome (VS) is a life-threatening form of distributive shock following cardiopulmonary bypass (CPB), characterised by profound vasodilatation, low systemic vascular resistance and refractory hypotension despite preserved cardiac output. Data from Latin American populations remain scarce. Objective To assess the prevalence, clinical characteristics and independent predictors of VS after cardiac surgery in a contemporary Mexican cohort. Methods We conducted a retrospective analytical cohort study including 788 adults undergoing cardiac surgery with CPB at our Institute between June 2022 and December 2023. VS was defined by systolic arterial pressure <80 mmHg and/or mean arterial pressure <50 mmHg, systemic vascular resistance index <800 dyn·s·cm⁻⁵·m², right atrial pressure <5 mmHg, pulmonary capillary wedge pressure <10 mmHg, cardiac index >2.2 L/min/m², and norepinephrine requirement >0.3 µg/kg/min. Demographic, surgical, haemodynamic and pharmacological variables were compared between patients with and without VS. Multivariable logistic regression adjusted for clinically relevant covariates was used to identify independent predictors and outcomes. Results VS occurred in 59 patients (7.48%, 95% CI 5.7–9.6). Compared with patients without VS, those with VS more frequently had previous cardiac surgery (20.3% vs 10.4; p=0.02) and NYHA functional class III (35.6% vs 20.3; p=0.008). VS was associated with higher EuroSCORE (2.46 vs 1.94; p=0.0013), longer CPB duration (177 vs 141 min; p=0.0007), longer aortic cross-clamp time (118 vs 96 min; p=0.0012), and a greater proportion of Bentall–De Bono procedures (15.2% vs 5.0; p=0.001). VS was independently associated with acute kidney injury (OR 4.25; p<0.001), need for renal replacement therapy (OR 6.35; p<0.001), postoperative atrial fibrillation (OR 2.54; p=0.002) and in-hospital mortality (OR 6.16; p<0.001). Conclusions In this contemporary Mexican cohort, VS occurred in 7.48% of patients undergoing cardiac surgery with CPB and was strongly associated with increased morbidity and mortality. High-risk clinical and procedural features are identifiable peri-operatively, supporting the need for early risk stratification and targeted preventive strategies.
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Medina et al. (2026) conducted a cohort in Vasoplegic syndrome after cardiac surgery with cardiopulmonary bypass (n=788). Vasoplegic syndrome after cardiopulmonary bypass vs. Patients without vasoplegic syndrome was evaluated on In-hospital mortality (OR 6.16, p=<0.001). Vasoplegic syndrome occurred in 7.48% of patients after cardiopulmonary bypass and was independently associated with higher in-hospital mortality (OR 6.16; p<0.001) and AKI (OR 4.25; p<0.001).
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