• Ara Klijian, Ashish K Khanna, V Seenu Reddy, Bruce Friedman, Jamel Ortoleva, Adam S Evans, Rakshit Panwar, Stew Kroll, Charles R Greenfeld, and Subhasis Chatterjee.
• Department of Cardiothoracic Surgery, Sharp and Scripps Healthcare, San Diego, CA.
• J. Cardiothorac. Vasc. Anesth. 2021 Jan 1; 35 (1): 51-58.

ObjectiveThe present study investigated outcomes in patients with vasoplegia after cardiac surgery treated with angiotensin II plus standard-of-care vasopressors. Vasoplegia is a common complication in cardiac surgery with cardiopulmonary bypass and is associated with significant morbidity and mortality. Approximately 250,000 cardiac surgeries with cardiopulmonary bypass are performed in the United States annually, with vasoplegia occurring in 20%to-27% of patients.DesignPost-hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study.SettingMulticenter, multinational study.ParticipantsSixteen patients with vasoplegia after cardiac surgery with cardiopulmonary bypass were enrolled.InterventionsAngiotensin II plus standard-of-care vasopressors (n = 9) compared with placebo plus standard-of-care vasopressors (n = 7).Measurements And Main ResultsThe primary endpoint was mean arterial pressure response (mean arterial pressure ≥75 mmHg or an increase from baseline of ≥10 mmHg at hour 3 without an increase in the dose of standard-of-care vasopressors). Vasopressor sparing and safety also were assessed. Mean arterial pressure response was achieved in 8 (88.9%) patients in the angiotensin II group compared with 0 (0%) patients in the placebo group (p = 0.0021). At hour 12, the median standard-of-care vasopressor dose had decreased from baseline by 76.5% in the angiotensin II group compared with an increase of 7.8% in the placebo group (p = 0.0013). No venous or arterial thrombotic events were reported.ConclusionPatients with vasoplegia after cardiac surgery with cardiopulmonary bypass rapidly responded to angiotensin II, permitting significant vasopressor sparing.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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