Abstract
Vasopressin has been used to augment blood pressure; however, cardiovascular effects after cardiac surgery have not been well established. The primary objective of this study was to survey the current literature and quantify the pooled effect of vasopressin on hemodynamic parameters in children after pediatric cardiac surgery. A systematic review was conducted to identify studies characterizing the hemodynamic effects of vasopressin after pediatric cardiac surgery. Studies were assessed and those of satisfactory quality with pre- and post-vasopressin hemodynamics for each patient were included in the final analyses. 6 studies with 160 patients were included for endpoints during the first 2 h of infusions. Patients who received vasopressin infusion had greater mean, systolic, and diastolic blood pressures and lower heart rates at 2 h after initiation. 8 studies with 338 patients were included for the effects at 24 h. Patients who received vasopressin infusion had lower central venous pressures and decreased lactate concentrations 24 h after initiation. A subset analysis for children with functionally univentricular hearts found significant decrease in inotrope score and central venous pressure. A subset analysis for neonates found significant decrease in inotrope score and fluid balance. Vasopressin leads to decrease in heart rate and increase in blood pressure in the first 2 h of initiation. Later effects include decrease in inotrope score, central venous pressure, fluid balance, and in lactate within the first 24 h. Findings vary in neonates and in those with functionally univentricular hearts although beneficial effects are noted in both.
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References
Japundžić-Žigon N, Lozić M, Šarenac O, Murphy D (2020) Vasopressin & oxytocin in control of the cardiovascular system: an updated review. Curr Neuropharmacol 18:14–33
Loomba RS, Flores S (2019) Use of vasoactive agents in postoperative pediatric cardiac patients: insights from a national database. Congenit Heart Dis 14:1176–1184
Agrawal A, Singh VK, Varma A, Sharma R (2012) Intravenous arginine vasopressin infusion in refractory vasodilatory shock: a clinical study. Indian J Pediatr 79:488–493
Burton GL, Kaufman J, Goot BH, da Cruz EM (2011) The use of Arginine Vasopressin in neonates following the Norwood procedure. Cardiol Young 21:536–544
Lu Z, Wang X, Yang J, Li S, Yan J (2018) Vasopressin in vasodilatory shock for both left and right heart anomalous pediatric patients after cardiac surgery. Shock 50:173–177
Mastropietro CW, Clark JA, Delius RE, Walters HL 3rd, Sarnaik AP (2008) Arginine vasopressin to manage hypoxemic infants after stage I palliation of single ventricle lesions. Pediatr Crit Care Med 9:506–510
Rosenzweig EB, Starc TJ, Chen JM, Cullinane S, Timchak DM, Gersony WM, Landry DW, Galantowicz ME (1999) Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 100:182–186
Iliopoulos I, Flores S, Pratap JN, Cooper DS, Cassedy A, Nelson DP (2017) Arginine-vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function. Cardiol Young 27:1031–1040
Alten JA, Borasino S, Toms R, Law MA, Moellinger A, Dabal RJ (2012) Early initiation of arginine vasopressin infusion in neonates after complex cardiac surgery. Pediatr Crit Care Med 13:300–304
Bigelow AM, Ghanayem NS, Thompson NE, Scott JP, Cassidy LD, Woods KJ, Woods RK, Mitchell ME, Hraŝka V, Hoffman GM (2019) Safety and efficacy of vasopressin after fontan completion: a randomized pilot study. Ann Thorac Surg 108:1865–1874
Davalos MC, Barrett R, Seshadri S, Walters HL 3rd, Delius RE, Zidan M, Mastropietro CW (2013) Hyponatremia during arginine vasopressin therapy in children following cardiac surgery. Pediatr Crit Care Med 14:290–297
Kumar TK, Kashyap P, Figueroa M, Zurakowski D, Allen J, Ballweg JA, Sathanandam S, Ali M, Knott-Craig CJ (2016) Vasopressin after the fontan operation. World J Pediatr Congenit Heart Surg 7:43–48
Matok I, Rubinshtein M, Levy A, Vardi A, Leibovitch L, Mishali D, Barzilay Z, Paret G (2009) Terlipressin for children with extremely low cardiac output after open heart surgery. Ann Pharmacother 43:423–429
Nishibe S, Tsujita M (2012) The impact of intraoperative vasopressin infusion in complex neonatal cardiac surgery. Interact Cardiovasc Thorac Surg 15:966–972
Loomba RS, Dorsey V, Villarreal EG, Flores S (2019) The effect of milrinone on hemodynamic and gas exchange parameters in children. Cardiol Young 30:55–617
Mastropietro CW, Rossi NF, Clark JA, Chen H, Walters H 3rd, Delius R, Lieh-Lai M, Sarnaik AP (2010) Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 38:2052–2058
Lee J, Kim GB, Kwon HW, Kwon BS, Bae EJ, Noh CI, Lim HG, Kim WH, Lee JR, Kim YJ (2014) Safety and efficacy of the off-label use of milrinone in pediatric patients with heart diseases. Korean Circ J 44:320–327
Hummel J, Rücker G, Stiller B (2017) Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. Cochrane Database Syst Rev 8:011312
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RSL, SF, and KS contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JSF, CC, MV, and II. The first draft of the manuscript was written by JSF, EGV, and RSL. SF commented on previous versions of the manuscript. All authors read and approved the final manuscript. Reviewing and editing was done by CWM and RAB.
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Farias, J.S., Villarreal, E.G., Flores, S. et al. Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis. Pediatr Cardiol 42, 225–233 (2021). https://doi.org/10.1007/s00246-020-02496-8
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DOI: https://doi.org/10.1007/s00246-020-02496-8