Abstract
Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT)
and is associated with significant morbidity and mortality. We present a case of a
61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto;
Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated
with intravenous methylene blue and high-dose vasopressors, but developed acute kidney
injury requiring dialysis and a prolonged stay in the intensive care unit. This case
supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by
other studies, might warrant consideration for withholding treatment while awaiting
HT, particularly in patients with risk factors for vasoplegia.
Résumé
La vasoplégie touche jusqu’à 16 % des patients qui subissent une transplantation cardiaque
et est associée à une morbidité et à une mortalité significatives. Nous présentons
le cas d’un homme de 61 ans atteint de cardiomyopathie ischémique et traité par l’association
sacubitril/valsartan (Entresto; Novartis, Cambridge, Massachussetts) chez lequel est
apparue une hypotension artérielle profonde après une transplantation cardiaque. Il
a été traité par du bleu de méthylène administré par voie intraveineuse et des vasopresseurs
à haute dose, mais une lésion rénale aiguë est apparue, qui a nécessité une dialyse
et un séjour prolongé à l’unité des soins intensifs. Ce cas met en lumière le puissant
effet vasodilatateur de l’association sacubitril/valsartan et, s’il est confirmé par
d’autres études, pourrait justifier l’arrêt de ce traitement pendant la période d’attente
de la transplantation cardiaque, en particulier chez les patients présentant des facteurs
de risque de vasoplégie.
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References
- Incidence and impact of on-cardiopulmonary bypass vasoplegia during heart transplantation.ASAIO J. 2018; 64: 43-51
- 2017 Comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure.Can J Cardiol. 2017; 33: 1342-1433
- Angiotensin-neprilysin inhibition versus enalapril in heart failure.N Engl J Med. 2014; 371: 993-1004
- Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study.Lancet. 2010; 375: 1255-1266
- Pharmacodynamic and pharmacokinetic profiles of sacubitril/valsartan (LCZ696) in patients with heart failure and reduced ejection fraction.Cardiovasc Ther. 2016; 34: 191-198
Article info
Publication history
Published online: December 11, 2017
Accepted:
December 5,
2017
Received:
November 13,
2017
Footnotes
See page 343.e7 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
