Severe Vasoplegic Syndrome Treated with Angiotensin II and Hemoadsorption Therapy after Cardiac Surgery

Vasoplegic syndrome (VS) is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). The main pathophysiology mechanism of VS includes a systemic inflammatory response syndrome due to surgical trauma, release of pro-inflammatory mediators caused by blood contact with foreign surfaces of heart-lung machine (pump and tubing) and endothelial dysfunction due to loss of pulsatile flow. Preoperative use of angiotensin-converting enzyme inhibitors and beta-blockers, coronary surgery and longer duration of CPB increase the incidence of VS. VS is characterized by hypotension with high cardiac output and low systemic resistance; treatment includes fluid resuscitation and vasopressors. Current authors report a case of cardiac VS, unresponsive to conventional therapy and successfully treated with angiotensin II (ATII) and hemoadsorption therapy.