Purpose of Review

The contribution of continuous flow left ventricular assist devices (c-LVAD) to vasoplegic syndrome and postoperative outcomes after orthotopic heart transplant (OHT) is contested in the literature. A standardized definition of vasoplegic syndrome (VS) is needed to better recognize and manage vasoplegic shock.

Recent Findings

Vasoplegic syndrome occurs after orthotopic heart transplant more frequently than after other surgeries requiring cardiopulmonary bypass. c-LVADs lead to small vessel endothelial dysfunction and desensitized adrenal receptors; however, their contribution to the development of vasoplegia is debated in clinical studies. Pulsatility may mitigate vascular dysfunction resulting from long-term continuous flow, and should be further explored in the clinical setting when considering risk factors for vasoplegic syndrome.

Summary

The incidence of vasoplegic syndrome after orthotopic heart transplant is rising with the increasing use of c-LVAD bridge to therapy. Robust clinical studies are needed to advance our understanding and approach to mitigating VS after OHT.

中文翻译：

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连续流左心室辅助装置引起的血管麻痹

审查目的

连续流左心室辅助装置 (c-LVAD) 对原位心脏移植 (OHT) 后血管麻痹综合征和术后结果的贡献在文献中存在争议。血管麻痹综合征 (VS) 的标准化定义需要更好地识别和管理血管麻痹性休克。

最近的发现

与其他需要体外循环的手术相比，原位心脏移植术后更常发生血管麻痹综合征。c-LVADs 导致小血管内皮功能障碍和肾上腺受体脱敏；然而，它们对血管麻痹发展的贡献在临床研究中存在争议。搏动可以减轻长期连续血流导致的血管功能障碍，在考虑血管麻痹综合征的危险因素时应在临床环境中进一步探讨。

概括

原位心脏移植后血管麻痹综合征的发生率随着 c-LVAD 桥接治疗的使用增加而上升。需要强有力的临床研究来提高我们对减轻 OHT 后 VS 的理解和方法。