Vasoplegic syndrome occurs in 36.30% of patients undergoing durable LVAD insertion via cardiopulmonary bypassHeart failure patients face risks from vasoplegic syndrome after surgery

Journal of cardiothoracic and vascular anesthesia Published November 1, 2026 Study authors: Kumar Nicolas, Ortoleva Jamel P, Fitzsimons Michael G, Dalia Adam A, Michel Eriberto, Sawyer Tamara … PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Note that vasoplegic syndrome occurs in 36.30% of LVAD cases and is associated with higher mortality and morbidity.

This systematic review and meta-analysis synthesized data from 16 retrospective studies involving 3,121 durable LVAD insertions to evaluate the incidence and risk factors of vasoplegic syndrome (VS). The analysis found a pooled VS incidence of 36.30% (95% CI: 34.61%-38.02%).

Several factors were associated with an increased risk of VS, including male sex (RR 1.65, p = 0.008), INTERMACS profile \u22642 (RR 1.19, p = 0.009), repeat sternotomy (RR 1.30, p = 0.020), and concomitant procedures (RR 1.27, p = 0.003). Additionally, longer cardiopulmonary bypass duration was associated with VS (WMD 13.17 minutes, p < 0.001).

Patients with VS experienced higher odds of adverse outcomes, including right ventricular failure (OR 1.76, p < 0.001), renal replacement therapy (OR 1.77, p < 0.001), and reoperation for bleeding (OR 2.46, p < 0.001). These patients also had longer ICU stays (10.00 vs 6.34 days, p < 0.001) and higher mortality rates at 30 days (14.85% vs 5.63%, p < 0.001) and 1 year (33.88% vs 22.62%, p = 0.030).

The authors note that all included studies were retrospective, which may limit the certainty of the findings. These results may assist in preoperative risk stratification and the development of targeted intervention strategies for patients undergoing LVAD insertion.

How this fits prior evidence

This meta-analysis addresses a gap in identifying specific risk factors and clinical outcomes associated with vasoplegic syndrome during LVAD insertion. While previous coverage noted that metabolic alkalosis is an uncertain prognostic marker in acute heart failure, this study provides specific risk factors like male sex and CPB duration for vasoplegic syndrome. It also identifies specific clinical associations for LVAD patients, such as increased odds of renal replacement therapy and higher 1-year mortality rates (33.88% vs 22.62%) in patients with VS.

When patients with heart failure receive a durable left ventricular assist device (LVAD), they can face a serious complication called vasoplegic syndrome. This condition involves a sudden drop in blood pressure and is a significant concern for doctors and patients during and after surgery. A review of 16 studies involving over 3,000 patients found that about 36% of those who received the heart pump experienced this syndrome.

Researchers identified several factors that increase the risk of this condition, including being male, having a more severe illness profile, and undergoing longer surgeries. The study also showed that patients who experience vasoplegic syndrome face much tougher outcomes. These patients were more likely to need kidney replacement therapy, experience heart failure in the right side of the heart, or require surgery to stop bleeding.

Because of these risks, patients with this condition stayed in the intensive care unit for longer periods. Most importantly, the data showed a link to higher mortality rates at both 30 days and one year after surgery. While these findings are based on retrospective data, they help doctors better identify which patients might need extra monitoring and targeted care during their recovery.

What this means for you:

Vasoplegic syndrome is a common complication after heart pump surgery linked to higher risks of organ failure and death.

Common questions

What is vasoplegic syndrome and how common is it?

Vasoplegic syndrome is a condition involving a drop in blood pressure that can occur after heart surgery. In a review of 16 studies, it was found that about 36.30% of patients who received a durable left ventricular assist device (LVAD) experienced this syndrome.

What factors increase the risk of this condition?

Several factors are linked to a higher risk of vasoplegic syndrome, including being male, having a more severe illness profile (INTERMACS score of 2 or less), undergoing longer procedures, and having a repeat surgery (sternotomy).

What are the risks if a patient develops this syndrome?

Patients who develop vasoplegic syndrome face higher risks of right ventricular failure and needing kidney replacement therapy. They also face a higher risk of needing surgery for bleeding and staying in the intensive care unit for a longer period.

Does this condition affect survival rates?

Yes, the data shows a link to higher mortality. Patients with vasoplegic syndrome had a 14.85% mortality rate at 30 days compared to 5.63% for those without it, and a 33.88% mortality rate at one year compared to 22.62%.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up12.0 mo

PublishedNov 2026

PMID42552137

View Original Abstract ↓

OBJECTIVES: To determine the incidence of vasoplegic syndrome (VS) following durable left ventricular assist device (LVAD) insertion and to identify associated risk factors and clinical outcomes. DESIGN: Systematic review and meta-analysis conducted per PRISMA guidelines, with risk of bias assessed using the Newcastle-Ottawa Scale. Meta-analysis calculated relative risks (RR), odds ratios (OR), and weighted mean differences (WMD). SETTING: Systematic search of MEDLINE and EMBASE from inception to May 1, 2026. PARTICIPANTS: Adults undergoing durable LVAD insertion across 16 retrospective studies, encompassing 3,121 LVAD insertions with 1,093 identified VS cases. INTERVENTIONS: Durable LVAD insertion via cardiopulmonary bypass (CPB). MEASUREMENTS AND MAIN RESULTS: The pooled VS incidence was 36.30% (95% CI: 34.61%-38.02%). Risk factors included male sex (RR 1.65, p = 0.008), INTERMACS profile ≤2 (RR 1.19, p = 0.009), repeat sternotomy (RR 1.30, p = 0.020), concomitant procedures (RR 1.27, p = 0.003), and longer CPB duration (WMD 13.17 minutes, p < 0.001). VS was associated with increased right ventricular failure (OR 1.76, p < 0.001), renal replacement therapy (OR 1.77, p < 0.001), reoperation for bleeding (OR 2.46, p < 0.001), and prolonged ICU stay (10.00 v 6.34 days, p < 0.001). Mortality was significantly higher in patients with VS at both 30 days (14.85% v 5.63%, p < 0.001) and 1 year (33.88% v 22.62%, p = 0.030). CONCLUSION: VS affects approximately one-third of LVAD recipients and is associated with substantially increased postoperative morbidity and mortality. The identified risk factors support preoperative risk stratification and the development of targeted intervention strategies.

Vasoplegic syndrome occurs in 36.30% of patients undergoing durable LVAD insertion via cardiopulmonary bypassHeart failure patients face risks from vasoplegic syndrome after surgery

How this fits prior evidence

Common questions

Study Details

Bivalirudin reduces in-hospital major bleeding and 30-day mortality in patients with acute coronary syndrome

Bivalirudin shows lower bleeding risks than heparin for heart patients

Clinical research that matters. Delivered to your inbox.

Vasoplegic syndrome occurs in 36.30% of patients undergoing durable LVAD insertion via cardiopulmonary bypassHeart failure patients face risks from vasoplegic syndrome after surgery

How this fits prior evidence

Common questions

More on Heart Failure

Study Details

Bivalirudin reduces in-hospital major bleeding and 30-day mortality in patients with acute coronary syndrome

Bivalirudin shows lower bleeding risks than heparin for heart patients

Clinical research that matters. Delivered to your inbox.

Related in Cardiology

From Other Specialties