The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia
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INVITED REVIEW ARTICLE
The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia Olga Papazisi 1
&
Meindert Palmen 1 & A. H. Jan Danser 2
Accepted: 11 October 2020 # The Author(s) 2020
Abstract Purpose Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population. Methods Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures). Results The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study. Conclusions AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available. Keywords Angiotensin II . Vasoplegia . Cardiopulmonary bypass . Cardiac surgery
Introduction Vasoplegia is a complication that occurs in 5–25% of patients that undergo cardiac surgery on cardiopulmonary bypass (CPB) [1, 2]. It is defined by profound hypotension, low systemic vascular resistance (SVR), normal or increased cardiac output (CO), and a blunted or, sometimes, absent response to the administration of fluids and vasopressors [3]. Persistent Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07098-3) contains supplementary material, which is available to authorized users. * Olga Papazisi [email protected] 1
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
2
Department of Internal Medicine, Division of Pharmacology, Erasmus Medical Center, Rotterdam, The Netherlands
hypotension leads to tissue hypoperfusion that might, ultimately, result in end-organ dysfunction. Therefore, vasoplegia is associated with increased perioperative morbidity and mortality [4–6]. Despite the fact that this syndro
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