Objectives: Patients with left-sided heart dysfunction and volume overload often have associated elevations in vasopressin from neuroendocrine activation. The authors investigated perioperative levels of vasopressin in patients with isolated right-sided heart dysfunction from chronic thromboembolic pulmonary hypertension.
Design: Prospective, observational study.
Setting: Single center, tertiary hospital.
Participants: Patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy.
Interventions: Vasopressin levels were measured in 22 patients during the perioperative period.
Measurements and main results: Vasopressin was undetectable in 8/22 patients at baseline. As a group, vasopressin levels at baseline and after induction of anesthesia were 0.8 pg/mL (median; 0.5-1.5, interquartile range of 25% and 75%) and 0.7 pg/mL (median; 0.5-1.4, interquartile range of 25% and 75%), respectively. During cardiopulmonary bypass (CPB), vasopressin increased to 13.9 pg/mL (median; 6.7-19.9, interquartile range of 25% and 75%). Vasopressin remained elevated after deep hypothermic circulatory arrest (DHCA) at 10.5 pg/mL (median; 6.5-19.9 interquartile range of 25% and 75%) and after CPB at 19.9 pg/mL (median; 11.1-19.9 interquartile range of 25% and 75%).
Conclusions: Vasopressin levels in PTE patients are in the low-to-normal range at baseline and may be a clinically relevant issue in the hemodynamic management of PTE.
Keywords: chronic thromboembolic pulmonary hypertension (CTEPH); neuroendocrine activation; pulmonary thromboendarterectomy (PTE); right-sided heart dysfunction; vasopressin deficiency.
Copyright © 2014 Elsevier Inc. All rights reserved.