Produção Nacional
Revisado por pares
Letter by Gomes and Evora Regarding Article, “Early On-Cardiopulmonary Bypass Hypotension and Other Factors Associated With Vasoplegic Syndrome”
2010; Lippincott Williams & Wilkins; Volume: 121; Issue: 22 Linguagem: Inglês
10.1161/circulationaha.109.925156
ISSN1524-4539
AutoresWalter J. Gomes, Paulo Roberto Barbosa Évora,
Tópico(s)Congenital Heart Disease Studies
ResumoHomeCirculationVol. 121, No. 22Letter by Gomes and Evora Regarding Article, "Early On-Cardiopulmonary Bypass Hypotension and Other Factors Associated With Vasoplegic Syndrome" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Gomes and Evora Regarding Article, "Early On-Cardiopulmonary Bypass Hypotension and Other Factors Associated With Vasoplegic Syndrome" Walter J. Gomes, MD, PhD Paulo R. Evora, MD, PhD Walter J. GomesWalter J. Gomes Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil Paulo R. EvoraPaulo R. Evora Division of Thoracic and Cardiovascular Surgery, Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil Originally published8 Jun 2010https://doi.org/10.1161/CIRCULATIONAHA.109.925156Circulation. 2010;121:e431To the Editor:The article by Levin et al1 represents a major contribution to the understanding of basic mechanisms involved in the emergence of vasoplegic syndrome (VS), a recently recognized and dreadful condition that affects patients in the postoperative period of cardiovascular surgery.However, the Introduction's assertion that this entity occurs after separation from cardiopulmonary bypass is no longer realistic. The incidence of VS has evolved from the boundaries of earlier descriptions, and these days, widespread occurrence has been reported. Although a lack of consistency in its definition and the absence of specific biomarkers make it difficult to fully characterize this syndrome, the clinical and hemodynamic events observed have been associated with excessive production of nitric oxide.2VS was initially described as a condition intrinsically linked to cardiopulmonary bypass use in cardiovascular surgery. However, further studies identified the occurrence of VS in patients who underwent off-pump coronary artery bypass surgery, revealing the multifactorial connections associated with the emergence of this syndrome.3Sun et al,4 in a fresh study reviewing their case series on off-pump coronary artery bypass, demonstrated a remarkable change in which VS turned out to be the most common isolated postoperative complication after off-pump coronary artery bypass (except atrial fibrillation), ahead of rates of stroke, myocardial infarction, renal failure, and major infections. More recently, an additional report5 describes VS that complicates the postoperative course of liver transplantation.Methylene blue has been recommended as a therapeutic option for catecholamine-resistant VS, with promising results demonstrating attenuation of severity and improved outcomes5; however, the role and effectiveness of methylene blue in this particular condition remain undetermined. Therefore, the information provided by Levin and colleagues1 is central and welcome, likely making it feasible to predict the occurrence of VS on the basis of an intraoperative decline in mean arterial pressure. Certainly, additional prospective studies should be conducted to confirm such findings.DisclosuresNone. References 1 Levin MA, Lin HM, Castillo JG, Adams DH, Reich DL, Fischer GW. Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome. Circulation. 2009; 120: 1664–1671.LinkGoogle Scholar2 Evora PRB, Ribeiro PJF, Vicente WVA, Reis CL, Rodrigues AJ, Menardi AC, Alves L Jr, Évora PM, Bassetto S. Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties. Rev Bras Cir Cardiovasc. 2009; 24: 279–288.CrossrefMedlineGoogle Scholar3 Gomes WJ, Erlichman MR, Batista-Filho ML, Knobel M, Almeida DR, Carvalho AC, Catani R, Buffolo E. Vasoplegic syndrome after off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg. 2003; 23: 165–169.CrossrefMedlineGoogle Scholar4 Sun X, Zhang L, Hill PC, Lowery R, Lee AT, Molyneaux RE, Corso PJ, Boyce SW. Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery? Eur J Cardiothorac Surg. 2008; 34: 820–825.CrossrefMedlineGoogle Scholar5 Cao Z, Gao Y, Tao G. Vasoplegic syndrome during liver transplantation. Anesth Analg. 2009; 108: 1941–1943.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 8, 2010Vol 121, Issue 22 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.109.925156PMID: 20530017 Originally publishedJune 8, 2010 PDF download Advertisement SubjectsCardiovascular SurgeryCatheter Ablation and Implantable Cardioverter-DefibrillatorEndothelium/Vascular Type/Nitric OxideEpidemiology
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