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Patient factors associated with RAAS dysfunction
in perioperative vasoplegia-related hypotension1-4

Disease-related
factors:

Long CPB duration 
CPB-related endothelial injury can reduce pulmonary and renal ACE activity, limiting ANG II production1

Diabetes
Diabetes-related endothelial injury can reduce renal ACE activity2

CKD
In CKD, renin release is dysregulated, which may blunt ANG II activity3

Medication-related factors:

Preoperative use of ACE inhibitors
ACE inhibitors blunt conversion of ANG I to ANG II4

Preoperative use of ARBs 
ARBs block AT1 receptor activity3

In cases where RAAS dysfunction is suspected, ANG II
supplementation may help restore hemodynamic stability4

Patient factors associated with RAAS dysfunction in perioperative vasoplegia-related hypotension1-4

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Disease-related
factors:

Long CPB duration 
CPB-related endothelial injury can reduce pulmonary and renal ACE activity,
limiting ANG II production1

Diabetes
Diabetes-related endothelial injury can
reduce renal ACE activity2

CKD 
In CKD, renin release is dysregulated,
which may blunt ANG II activity3

Medication-related factors:

Preoperative use of ACE inhibitors
ACE inhibitors blunt conversion of
ANG I to ANG II4

Preoperative use of ARBs 
ARBs block AT1 receptor activity3

In cases where RAAS dysfunction is suspected, ANG II supplementation may help restore hemodynamic stability4

Vasoplegia is a major hemodynamic challenge following cardiothoracic surgery involving CPB5,6






of patients who undergo CPB
may develop vasoplegia5,6

 

 

 

among patients with predisposing
risk factors for vasoplegia6

Cardiac surgery-related vasoplegia is associated
with significant morbidity and mortality1,7

 Higher risk of death      Longer ICU and hospital stays   
 Frequent readmissions      Longer ventilator use   
  Increased respiratory failure and major infection   
 Higher risk of acute kidney injury

Vasoplegia is a major hemodynamic challenge following cardiothoracic surgery involving CPB5,6






of patients who undergo CPB
may develop vasoplegia5,6

 



among patients with predisposing
risk factors for vasoplegia6

Cardiac surgery-related vasoplegia is associated with significant morbidity and mortality1,7

 Higher risk of death
 Longer ICU and hospital stays   
 Frequent readmissions
 Longer ventilator use
 Increased respiratory failure and major infection  
 Higher risk of acute kidney injury

ACE=angiotensin converting enzyme; ANG=angiotensin; ARB=angiotensin receptor blocker; AT1=ANG II type 1; CKD=chronic kidney disease; CPB=cardiopulmonary bypass; ICU=intensive care unit; RAAS=renin-angiotensin-aldosterone system.

References: 1. Tsiouris A, et al. Gen Thorac Cardiovasc Surg. 2017;65(10):557-565. 2. Hsueh WA, et al. J Clin Hypertens (Greenwich). 2011;13(4):224-237. 3. Ma TK, et al. Br J Pharmacol. 2010;160(6):1273-1292. 4. Bellomo R, et al. Am J Respir Crit Care Med. 2020;202(9):1253-1261. 5. Levin MA, et al. Circulation. 2009;120(17):1664-1671. 6. Weis F, et al. Anaesthesia. 2006;61(10):938-942. 7. Chen M, et al. J Heart Lung Transplant. 2014;33(4)(suppl):S132. Abstract 348.

ACE=angiotensin converting enzyme; ANG=angiotensin; ARB=angiotensin receptor blocker; AT1=ANG II type 1; CKD=chronic kidney disease; CPB=cardiopulmonary bypass; ICU=intensive care unit; RAAS=renin-angiotensin-aldosterone system.

References: 1. Tsiouris A, et al. Gen Thorac Cardiovasc Surg. 2017;65(10):557-565. 2. Hsueh WA, et al. J Clin Hypertens (Greenwich). 2011;13(4):224-237. 3. Ma TK, et al. Br J Pharmacol. 2010;160(6):1273-1292. 4. Bellomo R, et al. Am J Respir Crit Care Med. 2020;202(9):1253-1261. 5. Levin MA, et al. Circulation. 2009;120(17):1664-1671. 6. Weis F, et al. Anaesthesia. 2006;61(10):938-942. 7. Chen M, et al. J Heart Lung Transplant. 2014;33(4)(suppl):S132. Abstract 348.

© 2025 Innoviva Specialty Therapeutics™. All rights reserved.
NP-GIA-US-0001 | 12/25
© 2025 Innoviva Specialty Therapeutics™. All rights reserved.
NP-GIA-US-0001 | 12/25