Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-09T15:59:23.242Z Has data issue: false hasContentIssue false
  • English
  • Français

Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function

Published online by Cambridge University Press:  14 December 2016

Ilias Iliopoulos ,
Saul Flores ,
J. N. Pratap ,
David S. Cooper ,
Amy Cassedy  and
David P. Nelson
Ilias Iliopoulos*
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
Saul Flores
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
J. N. Pratap
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
David S. Cooper
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
Amy Cassedy
Affiliation:
Heart Institute Research Core, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
David P. Nelson
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
*
Correspondence to: I. Iliopoulos, MD, Cincinnati Children’s Hospital Medical Center, Heart Institute, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229-3026, United States of America. Tel: +15138039218; Fax: +15136363952; E-mail: ilias.iliopoulos@cchmc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine–vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine–vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as “responders” if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine–vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1–26.9), and the median weight was 4.3 kg (3.2–5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the “target” arginine–vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine–vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.

Keywords

Arginine–vasopressincardiac surgeryhypotensionventricular dysfunctioncardiopulmonary bypassCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1031 - 1040
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100 (Suppl): II182–II186.CrossRefGoogle ScholarPubMed
2. Lechner, E, Hofer, A, Mair, R, Moosbauer, W, Sames-Dolzer, E, Tulzer, G. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 1221–1227.CrossRefGoogle ScholarPubMed
3. Alten, JA, Borasino, S, Toms, R, Law, MA, Moellinger, A, Dabal, RJ. Early initiation of arginine vasopressin infusion in neonates after complex cardiac surgery. Pediatr Crit Care Med 2012; 13: 300–304.CrossRefGoogle ScholarPubMed
4. Mastropietro, CW, Davalos, MC, Seshadri, S, Walters, HL III, Delius, RE. Clinical response to arginine vasopressin therapy after paediatric cardiac surgery. Cardiol Young 2013; 23: 387–393.CrossRefGoogle ScholarPubMed
5. Mastropietro, CW, Rossi, NF, Clark, JA, et al. Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 2010; 38: 2052–2058.CrossRefGoogle ScholarPubMed
6. Morrison, WE, Simone, S, Conway, D, Tumulty, J, Johnson, C, Cardarelli, M. Levels of vasopressin in children undergoing cardiopulmonary bypass. Cardiol Young 2008; 18: 135–140.CrossRefGoogle ScholarPubMed
7. Indrambarya, T, Boyd, JH, Wang, Y, McConechy, M, Walley, KR. Low-dose vasopressin infusion results in increased mortality and cardiac dysfunction following ischemia-reperfusion injury in mice. Crit Care 2009; 13: R98.CrossRefGoogle ScholarPubMed
8. Mastropietro, CW. Arginine vasopressin in neonates after surgery for congenital heart disease: right from the start? Pediatr Crit Care Med 2012; 13: 360–361.CrossRefGoogle ScholarPubMed
9. Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
10. Asfar, P, Radermacher, P. Vasopressin and ischaemic heart disease: more than coronary vasoconstriction? Crit Care 2009; 13: 169.CrossRefGoogle ScholarPubMed
11. Walker, BR, Childs, ME, Adams, EM. Direct cardiac effects of vasopressin: role of V1- and V2-vasopressinergic receptors. Am J Physiol 1988; 255: H261–H265.Google ScholarPubMed
12. Fenton, RA, Brønd, L, Nielsen, S, Praetorius, J. Cellular and subcellular distribution of the type-2 vasopressin receptor in the kidney. Am J Physiol Renal Physiol 2007; 293: F748–F760.CrossRefGoogle ScholarPubMed
13. Holmes, CL, Patel, BM, Russell, JA, Walley, KR. Physiology of vasopressin relevant to management of septic shock. Chest 2001; 120: 989–1002.CrossRefGoogle ScholarPubMed
14. Diéguez, G, Martínez, MA, Fernández, N, Climént, B, García-Villalón, AL, Monge, L. Vasopressin effects on the coronary circulation after a short ischemia in anesthetized goats: role of nitric oxide and prostanoids. Eur J Pharmacol 2004; 495: 171–177.CrossRefGoogle Scholar
15. Noguera, I, Medina, P, Segarra, G, et al. Potentiation by vasopressin of adrenergic vasoconstriction in the rat isolated mesenteric artery. Br J Pharmacol, 122: 431–438.CrossRefGoogle Scholar
16. Lindner, KH, Prengel, AW, Pfenninger, EG, et al. Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation 1995; 91: 215–221.CrossRefGoogle ScholarPubMed
17. Wilson, MF, Brackett, DJ, Archer, LT, Hinshaw, LB. Mechanisms of impaired cardiac function by vasopressin. Ann Surg 1980; 191: 494–500.CrossRefGoogle ScholarPubMed
18. Sellke, FW, Quillen, JE. Altered effects of vasopressin on the coronary circulation after ischemia. J Thorac Cardiovasc Surg 1992; 104: 357–363.CrossRefGoogle ScholarPubMed
19. Nazari, A, Sadr, SS, Faghihi, M, Imani, A, Moghimian, M. The cardioprotective effect of different doses of vasopressin (AVP) against ischemia-reperfusion injuries in the anesthetized rat heart. Peptides 2011; 32: 2459–2466.CrossRefGoogle ScholarPubMed
20. Boyle, WA 3rd, Segel, LD. Direct cardiac effects of vasopressin and their reversal by a vascular antagonist. Am J Physiol 1986; 251: H734–H741.Google ScholarPubMed
21. Dünser, MW, Hasibeder, WR. Vasopressin in vasodilatory shock: ensure organ blood flow, but take care of the heart!. Crit Care 2006; 10: 172.CrossRefGoogle ScholarPubMed
22. Xu, YJ, Gopalakrishnan, V. Vasopressin increases cytosolic free [Ca2+] in the neonatal rat cardiomyocyte. Evidence for V1 subtype receptors. Circ Res 1991; 69: 239–245.CrossRefGoogle ScholarPubMed
23. Gassanov, N, Jankowski, M, Danalache, B, et al. Arginine vasopressin-mediated cardiac differentiation: insights into the role of its receptors and nitric oxide signaling. J Biol Chem 2007; 282: 11255–11265.CrossRefGoogle ScholarPubMed
24. Gold, J, Cullinane, S, Chen, J, et al. Vasopressin in the treatment of milrinone-induced hypotension in severe heart failure. Am J Cardiol 2000; 85: 506–508, A11.CrossRefGoogle ScholarPubMed
25. Dünser, MW, Mayr, AJ, Stallinger, A, et al. Cardiac performance during vasopressin infusion in postcardiotomy shock. Intensive Care Med 2002; 28: 746–751.CrossRefGoogle ScholarPubMed
26. Burton, GL, Kaufman, J, Goot, BH, da Cruz, EM. The use of arginine vasopressin in neonates following the Norwood procedure. Cardiol Young 2011; 21: 536–544.CrossRefGoogle ScholarPubMed
27. Cingolani, HE, Pérez, NG, Cingolani, OH, Ennis, IL. The Anrep effect: 100 years later. Am J Physiol Heart Circ Physiol 2013; 304: H175–H182.CrossRefGoogle ScholarPubMed
28. Villa-Abrille, MC, Caldiz, CI, Ennis, IL, et al. The Anrep effect requires transactivation of the epidermal growth factor receptor. J Physiol 2010; 588 (Pt 9): 1579–1590.CrossRefGoogle ScholarPubMed
29. Asfar, P, Radermacher, P, Hauser, B. Vasopressin and splanchnic blood flow: vasoconstriction does not equal vasoconstriction in every organ. Intensive Care Med 2006; 32: 21–23.CrossRefGoogle Scholar
30. Van Haren, FM, Rozendaal, FW, van der Hoeven, JG. The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock. Chest 2003; 124: 2256–2260.CrossRefGoogle ScholarPubMed
31. Pelletier, JS, LaBossiere, J, Dicken, B, et al. Low-dose vasopressin improves cardiac function in newborn piglets with acute hypoxia-reoxygenation. Shock 2013; 40: 320–326.CrossRefGoogle ScholarPubMed
32. Edwards, RM, Trizna, W, Kinter, LB. Renal microvascular effects of vasopressin and vasopressin antagonists. Am J Physiol 1989; 256 (2 Pt 2): F274–F278.Google ScholarPubMed
33. Edwards, RM, Grantham, JJ. Inhibition of vasopressin action by vanadate in the cortical collecting tubule. Am J Physiol 1983; 245: F772–F777.Google ScholarPubMed
34. Patel, BM, Chittock, DR, Russell, JA, Walley, KR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002; 96: 576–582.CrossRefGoogle ScholarPubMed
35. Reardon, DP, DeGrado, JR, Anger, KE, et al. Early vasopressin reduces incidence of new onset arrhythmias. J Crit Care 2014; 29: 482–485.CrossRefGoogle ScholarPubMed