Cardiac vasoplegia syndrome: pathophysiology, risk factors and treatment

Am J Med Sci. 2015 Jan;349(1):80-8. doi: 10.1097/MAJ.0000000000000341.


Vasoplegia syndrome is a well known complication after cardiac surgery and has a significant morbidity and mortality. It is characterized by profound vasodilation and loss of systemic vascular resistance leading to hypotension. The pathogenesis of vasoplegia involves the activation of contact, coagulation and complement systems and the activation of leukocytes, platelets and endothelial cells resulting in an imbalance in the regulation of the vascular tone leading to postcardiac surgery vasoplegia. Multiple risk factors have been identified that help predict vasoplegia. Treatment requires mainly vasopressors, but hypotension can be refractory to vasopressors. Some studies suggest that methylene blue can reverse refractory hypotension in these patients and may prevent the development of the syndrome, but more studies are needed with this drug. In this review, we will discuss the pathophysiology of the vasoplegia syndrome and associated risk factors for this complication and briefly outline current therapeutic strategies.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Cardiopulmonary Bypass / adverse effects*
  • Catecholamines / therapeutic use
  • Heart Diseases* / drug therapy
  • Heart Diseases* / etiology
  • Heart Diseases* / physiopathology
  • Humans
  • Prognosis
  • Risk Factors
  • Vasoconstrictor Agents / therapeutic use
  • Vasoplegia* / drug therapy
  • Vasoplegia* / etiology
  • Vasoplegia* / physiopathology


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Catecholamines
  • Vasoconstrictor Agents