• Marieke E van Vessem, Beeres Saskia L M A SLMA Department of Cardiology, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands., de Wilde Rob B P RBP Department of Intensive Care, Leiden University Medical Center, Leiden, the Netherlands., René de Vries, Remco R Berendsen, Evert de Jonge, Danser A H Jan AHJ Department of Internal medicine, Erasmus Medical Center, Rotterdam, The Netherlands., Klautz Robert J M RJM Department of Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands., Martin J Schalij, and Meindert Palmen.
• Department of Cardiology, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands. M.E.van_Vessem@lumc.nl.
• J Cardiothorac Surg. 2019 Nov 21; 14 (1): 200.

BackgroundVasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with heart failure, before, during and after heart failure surgery and to identify the etiological factors involved.MethodsThis is a prospective, observational study conducted at Leiden University Medical Center. Patients with and patients without heart failure undergoing cardiac surgery on cardiopulmonary bypass are enrolled. The study is divided in two inclusion phases. During phase 1, 18 patients with and 18 patients without heart failure are enrolled. The vascular reactivity in response to a vasoconstrictor (phenylephrine) and a vasodilator (nitroglycerin) is assessed in vivo on different timepoints. The response to phenylephrine is assessed on t1 (before induction), t2 (before induction, after start of cardiotropic drugs and/or vasopressors), t3 (after induction), t4 (15 min after cessation of cardiopulmonary bypass) and t5 (1 day post-operatively). The response to nitroglycerin is assessed on t1 and t5. Furthermore, a sample of pre-pericardial fat tissue, containing resistance arteries, is collected intraoperatively. The ex vivo vascular reactivity is assessed by constructing concentrations response curves to various vasoactive substances using isolated resistance arteries. Next, expression of signaling proteins and receptors is assessed using immunohistochemistry and mRNA analysis. Furthermore, the groups are compared with respect to levels of organic compounds that can influence the cardiovascular system (e.g. copeptin, (nor)epinephrine, ANP, BNP, NTproBNP, angiotensin II, cortisol, aldosterone, renin and VMA levels). During inclusion phase 2, only the ex vivo vascular reactivity test is performed in patients with (N = 12) and without heart failure (N = 12).DiscussionUnderstanding the difference in vascular responsiveness between patients with and without heart failure in detail, might yield therapeutic options or development of preventive strategies for vasoplegia, leading to safer surgical interventions and improvement in outcome.Trial RegistrationThe Netherlands Trial Register (NTR), NTR5647. Registered 26 January 2016.

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