Vasoplegia After Left Ventricular Assist Device Implantation: A Meta-analysis of Incidence, Predictors, and Clinical Outcomes.

Authors

Leo Consoli, Michel Pompeu Sá, Gabriel Neves, Thiago Camarotti, Xander Jacquemyn, Federico Napoli, Jose L Navia, Nicolas A Brozzi, Antonio Polanco

Published in

Journal of cardiothoracic and vascular anesthesia. Aug 24, 2026. Epub Aug 24, 2026.

Abstract

To characterize the incidence, predictors, and clinical outcomes of vasoplegia following left ventricular assist device (LVAD) implantation.
Systematic review and study-level meta-analysis.
Tertiary care.
Patients receiving a continuous-flow LVAD.
No interventions were performed.
Medline, Embase, and the Cochrane Library were searched from inception to March 2026 for studies on continuous-flow LVADs reporting vasoplegia as an outcome. The incidence of vasoplegia was estimated as a pooled proportion. Comparative analysis was performed using random-effects meta-analysis by pooling risk ratios with 95% confidence intervals for binary endpoints or mean differences, if continuous. Long-term survival was evaluated using Kaplan-Meier-derived time-to-event data with a Cox frailty model to obtain hazard ratios. Risk factors from multivariable regression models were pooled to identify predictors. A 2-tailed p < 0.05 was considered statistically significant. RStudio was used for all analyses. Nine observational studies (n = 1,855) were included. Vasoplegia developed in 34.2% of patients (95% confidence interval, 26.9%-42.4%) and was associated with higher early mortality and major bleeding, as well as worse long-term survival and longer hospital stays. No difference was found in intensive care unit mortality, acute kidney injury, stroke, and right heart failure. Male sex and higher body mass index were identified as risk factors for vasoplegia, while higher blood pressure was protective. Renin-angiotensin-aldosterone inhibitors, β-blockers, neutrophil/lymphocyte ratio, Interagency Registry for Mechanically Assisted Circulatory Support classes I to II, cardiopulmonary bypass time, serum creatinine, diabetes, and ischemic cardiomyopathy were not significant predictors.
Vasoplegia affects approximately one-third of patients following LVAD implantation and is associated with worse postoperative outcomes.

PMID:
42760241
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

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