Cardiopulmonary bypass is associated with high risk of systemic inflammatory response. Ischemia and reperfusion of the myocardium and lungs, contact activation of leukocytes and blood coagulation factors activate release of various pro-inflammatory and vasoactive mediators. These agents result dysregulation of vascular tone, capillary leakage and deficiency of endogenous vasoconstrictors, such as vasopressin and others. Hypotension resistant to standard therapy with catecholamines is considered as refractory post-CPB vasoplegic syndrome. Terlipressin is a synthetic precursor of vasopressin and selective agonist of V1aR receptors. Half-life is 3-4 hours. This drug is widely used abroad to correct vasoplegic syndrome. However, terlipressin is not registered in Russia for correction of hypotension.

OBJECTIVE

To compare hemodynamic effects of terliprissin and increasing doses of norepinephrine for correction of refractory postperfusion vasoplegic syndrome.

MATERIAL AND METHODS

A prospective randomized single-center study included 34 patients aged 63±8 years with severe vasoplegic syndrome after on-pump (138±17 min) coronary artery bypass grafting (2±1 coronary arteries) and additional mitral valve repair in 12 patients.

RESULTS

Hemodynamic stabilization following terlipressin therapy (n=17) made it possible to reduce the dosage of norepinephrine from 480 (430-600) to 110 (50-300) ng/kg/min compared to standard therapy (n=17). It was also true after the end of terlipressin effect (300 (100-400) ng/kg/min). We also observed vasoconstrictor effect delayed by 16±6 min and transient cutaneous signs of vasoconstriction in 6 (35.3%) patients of this group.

CONCLUSION

Compared to norepinephrine, terlipressin is more effective but difficult for titration drug for correction of refractory vasoplegia. Further studies are required to develop effective schemes and algorithms for prescription of terlipressin.