RAAS Is Key
As you encounter perioperative vasoplegia, are you identifying patients with RAAS dysfunction? As you encounter perioperative vasoplegia, are you identifying patients with RAAS dysfunction?

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

Illustration of internal organs affected by RAAS dysfunction

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

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.