{"id":9055,"date":"2026-04-07T11:11:34","date_gmt":"2026-04-07T11:11:34","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/marieke-van-vessem\/"},"modified":"2026-04-23T08:24:40","modified_gmt":"2026-04-23T08:24:40","slug":"marieke-van-vessem","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/marieke-van-vessem\/","title":{"rendered":"Marieke Van Vessem"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":13527,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-9055","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"Vasoplegia after Heart Failure Surgery","samenvatting":"Hartfalen is een chronisch ziekte met hoge mortaliteit en morbiditeit. Voor geselecteerde pati\u00ebnten met hartfalen in stadium C en D is operatieve behandeling bewezen effectief. Een chirurgische ingreep is echter niet zonder risico's. Vasoplegie, een subtype van vasodilatoire shock, is een ernstige complicatie die kan optreden na een hartoperatie. Deze complicatie wordt vaker gezien bij pati\u00ebnten met dan bij pati\u00ebnten zonder hartfalen. Het wordt veroorzaakt door inactivering van vasoconstrictie- en activering van vasodilatatiemechanismen. Het doel van het onderzoek zoals beschreven in dit proefschrift was om meer inzicht te krijgen in de incidentie en risicofactoren van vasoplegie na hartfalenchirurgie. Daarnaast werden de gevolgen van deze complicatie, zowel in de eerste fase na de operatie als tijdens de lange termijn follow-up bestudeerd. Tot slot werden de mechanismen die verantwoordelijk zijn voor het verhoogde risico op vasoplegie in deze pati\u00ebntenpopulatie onderzocht.\n\nIn de algemene inleiding van dit proefschrift (hoofdstuk 1) werd een overzicht gegeven van de definitie, epidemiologie, pathofysiologie en behandeling van vasoplegie na hartfalenchirurgie. We stelden dat de kenmerken van hartfalenpati\u00ebnten hen vatbaarder maken voor het ontwikkelen van vasoplegie. Eerder werd vasoplegie na hartfalenchirurgie alleen bestudeerd na harttransplantatie en implantatie van een left ventricular assist device (LVAD, ook wel steunhart genoemd). In deze populaties werd vasoplegie geassocieerd met een slechtere klinische uitkomst.\n\nIn hoofdstuk 2 werd de incidentie, overleving en voorspellers van vasoplegie bij pati\u00ebnten die hartfalenchirurgie ondergingen onderzocht. Vasoplegie werd gedefinieerd als de continue behoefte aan vasopressoren (noradrenaline \u22650,2 \u00b5g\/kg\/min en\/of terlipressine (elke dosis)) in combinatie met een cardiac index \u22652,2 l\/min\/m2 gedurende tenminste 12 opeenvolgende uren, beginnend tijdens de eerste 3 dagen postoperatief. In totaal werden 225 hartfalenpati\u00ebnten met een linker ventrikel ejectiefractie (LVEF) \u226435% ge\u00efncludeerd, die chirurgisch een linker ventrikel reconstructie, CorCap of LVAD implantatie ondergingen. De incidentie van vasoplegie was 29%. Slechts 71% van de vasoplege pati\u00ebnten overleefden de eerste 90 dagen na de operatie, vergeleken met 91% van de niet-vasoplege pati\u00ebnten. Preoperatieve anemie en een hogere thyroxinespiegel waren geassocieerd met een verhoogd risico op vasoplegie. Daarentegen verminderden een hogere creatinineklaring en het gebruik van b\u00e8tablokkers het risico op vasoplegie. Er werd een risicomodel voorgesteld om het risico op postoperatieve vasoplegie te beoordelen. Dit model had een redelijk onderscheidend vermogen om pati\u00ebnten met een risico op vasoplegie te identificeren, door ze te verdelen in 3 risicocategorie\u00ebn: 1) laag risico (<25%), 2) intermediair risico (25-50%) en 3) hoog risico (>50%).","summary":"References\n\n1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021.\n2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Drazner MH, et al. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810-52.\n3. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC\/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541-619.\n4. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC\/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-91.\n5. Petrus AHJ, Klautz RJM, De Bonis M, Langer F, Sch\u00e4fers HJ, Wakasa S, et al. The optimal treatment strategy for secondary mitral regurgitation: a subject of ongoing debate. Eur J Cardiothorac Surg. 2019;56(4):631-42.\n6. Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23-32.\n7. Pibarot P, Delgado V, Bax JJ. MITRA-FR vs. COAPT: lessons from two trials with diametrically opposed results. Eur Heart J Cardiovasc Imaging. 2019;20(6):620-4.\n8. Klein P, Bax JJ, Shaw LJ, Feringa HH, Versteegh MI, Dion RA, et al. Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease. Eur J Cardiothorac Surg. 2008;34(6):1149-57.\n9. Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F. Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg. 1989;37(1):11-9.\n10. Witkowski TG, ten Brinke EA, Delgado V, Ng AC, Bertini M, Marsan NA, et al. Surgical ventricular restoration for patients with ischemic heart failure: determinants of two-year survival. Ann Thorac Surg. 2011;91(2):491-8.\n11. Jones RH, Velazquez EJ, Michler RE, Sopko G, Oh JK, O'Connor CM, et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med. 2009;360(17):1705-17.\n12. Doenst T, Velazquez EJ, Michler RE. Restoring ventricular restoration: A call to re-evaluate a surgical therapy considered ineffective. J Card Surg. 2021;36(2):693-5.\n13. Couperus LE, Delgado V, Palmen M, van Vessem ME, Braun J, Fiocco M, et al. Right ventricular dysfunction affects survival after surgical left ventricular restoration. J Thorac Cardiovasc Surg. 2017;153(4):845-52.\n14. Michler RE, Rouleau JL, Al-Khalidi HR, Bonow RO, Pellikka PA, Pohost GM, et al. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. J Thorac Cardiovasc Surg. 2013;146(5):1139-45.e6.\n15. Braun J, Ciarka A, Versteegh MI, Delgado V, Boersma E, Verwey HF, et al. Cardiac support device, restrictive mitral valve annuloplasty, and optimized medical treatment: a multimodality approach to nonischemic cardiomyopathy. J Thorac Cardiovasc Surg. 2011;142(3):e93-100.\n16. Hetzer R, Javier M, Wagner F, Loebe M, Javier Delmo EM. Organ-saving surgical alternatives to treatment of heart failure. Cardiovasc Diagn Ther. 2021;11(1):213-25.\n17. Haeck ML, Beeres SL, H\u00f6ke U, Palmen M, Couperus LE, Delgado V, et al. Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands. Neth Heart J. 2015;23(2):102-8.\n18. Kortekaas KA, Lindeman JH, Versteegh MI, van Beelen E, Kleemann R, Klautz RJ. Heart failure determines the myocardial inflammatory response to injury. Eur J Heart Fail. 2013;15(4):400-7.\n19. Busse LW, Barker N, Petersen C. Vasoplegic syndrome following cardiothoracic surgery-review of pathophysiology and update of treatment options. Crit Care. 2020;24(1):36.\n20. Byrne JG, Leacche M, Paul S, Mihaljevic T, Rawn JD, Shernan SK, et al. Risk factors and outcomes for 'vasoplegia syndrome' following cardiac transplantation. Eur J Cardiothorac Surg. 2004;25(3):327-32.\n21. Levin MA, Lin HM, Castillo JG, Adams DH, Reich DL, Fischer GW. Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome. Circulation. 2009;120(17):1664-71.\n22. Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and pathophysiology of vasoplegic shock. Crit Care. 2018;22(1):174.\n23. Dayan V, Cal R, Giangrossi F. Risk factors for vasoplegia after cardiac surgery: a meta-analysis. Interact Cardiovasc Thorac Surg. 2019;28(6):838-44.\n24. Fischer GW, Levin MA. Vasoplegia during cardiac surgery: current concepts and management. Semin Thorac Cardiovasc Surg. 2010;22(2):140-4.\n25. Chemmalakuzhy J, Costanzo MR, Meyer P, Piccione W, Kao W, Winkel E, et al. Hypotension, acidosis, and vasodilatation syndrome post-heart transplant: prognostic variables and outcomes. J Heart Lung Transplant. 2001;20(10):1075-83.\n26. Sun X, Zhang L, Hill PC, Lowery R, Lee AT, Molyneaux RE, et al. Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery? Eur J Cardiothorac Surg. 2008;34(4):820-5.\n27. Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg. 1998;116(6):973-80.\n28. Alfirevic A, Xu M, Johnston D, Figueroa P, Koch CG. Transfusion increases the risk for vasoplegia after cardiac operations. Ann Thorac Surg. 2011;92(3):812-9.\n29. Patarroyo M, Simbaqueba C, Shrestha K, Starling RC, Smedira N, Tang WH, et al. Pre-operative risk factors and clinical outcomes associated with vasoplegia in recipients of orthotopic heart transplantation in the contemporary era. J Heart Lung Transplant. 2012;31(3):282-7.\n30. Chan JL, Kobashigawa JA, Aintablian TL, Dimbil SJ, Perry PA, Patel JK, et al. Characterizing Predictors and Severity of Vasoplegia Syndrome After Heart Transplantation. Ann Thorac Surg. 2018;105(3):770-7.\n31. Chan JL, Kobashigawa JA, Aintablian TL, Li Y, Perry PA, Patel JK, et al. Vasoplegia after heart transplantation: outcomes at 1 year. Interact Cardiovasc Thorac Surg. 2017;25(2):212-7.\n32. Tecson KM, Lima B, Lee AY, Raza FS, Ching G, Lee CH, et al. Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation. J Am Heart Assoc. 2018;7(11).\n33. de Waal EEC, van Zaane B, van der Schoot MM, Huisman A, Ramjankhan F, van Klei WA, et al. Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence, outcomes and predictors. BMC Anesthesiol. 2018;18(1):185.\n34. Asleh R, Alnsasra H, Daly RC, Schettle SD, Briasoulis A, Taher R, et al. Predictors and Clinical Outcomes of Vasoplegia in Patients Bridged to Heart Transplantation With Continuous-Flow Left Ventricular Assist Devices. J Am Heart Assoc. 2019;8(22):e013108.\n35. Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol. 2017;14(1):30-8.\n\nGeneral introduction and thesis outline\n\n36. Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg. 2005;3(2):129-40.\n37. Schwinn DA, McIntyre RW, Hawkins ED, Kates RA, Reves JG. alpha 1-Adrenergic responsiveness during coronary artery bypass surgery: effect of preoperative ejection fraction. Anesthesiology. 1988;69(2):206-17.\n38. Papazisi O, Palmen M, Danser AHJ. The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia. Cardiovasc Drugs Ther. 2020.\n\nIncidence and predictors of vasoplegia after heart failure surgery\n\nM.E. van Vessem, M. Palmen, L.E. Couperus, B. Mertens, R.R. Berendsen, L.F. Tops, H.F. Verwey, E. de Jonge, R.J.M. Klautz, M.J. Schalij, S.L.M.A. Beeres\n\nEur J Cardiothorac Surg. 2017;51(3):532-\n\nAbstract\n\nObjectives: Vasoplegia has been described as a complication after cardiac surgery, particularly in patients with a poor left ventricular ejection fraction. The aim of the current study was to assess the incidence, survival and predictors of vasoplegia in patients undergoing heart failure surgery and to propose a risk model.\n\nMethods: A retrospective study including heart failure patients who underwent surgical left ventricular restoration, CorCap implantation or left ventricular assist device implantation between 2006-2015. Patients were classified by the presence or absence of vasoplegia.\n\nResults: 225 patients were included. The incidence of vasoplegia was 29%. The 90-day survival rate in vasoplegic patients was lower compared to non-vasoplegic patients (71% versus 91%, P<0.001). After adjusting for age, sex and surgical procedure, anaemia (OR 2.195; 95% CI 1.146, 4.204; P=0.018) and a higher thyroxine level (OR 1.140; 95% CI 1.033, 1.259; P=0.009) increased the risk of vasoplegia; a higher creatinine clearance (OR 0.980; 95% CI 0.965, 0.994; P=0.006) and beta-blocker use (OR 0.257; 95% CI 0.112, 0.589; P=0.001) decreased the risk. The risk model consisted of the same variables and could adequately identify patients at risk for vasoplegia.\n\nConclusions: Vasoplegia after heart failure surgery is common and results in a lower survival rate. Anaemia and a higher thyroxine level are associated with an increased risk on vasoplegia. In contrast, a higher creatinine clearance and beta-blocker use decrease the risk on vasoplegia. These factors are used in the risk model that may guide treatment strategy.","auteur":"Marieke Van Vessem","auteur_slug":"marieke-van-vessem","publicatiedatum":"20 september 2022","taal":"EN","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/mariekevanvessem?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202604071107","isbn":"978-94-6423-957-7","doi_nummer":"","naam_universiteit":"Universiteit Leiden","afbeeldingen":13527,"naam_student:":"","binnenwerk":"","universiteit":"Universiteit Leiden","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/9055","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=9055"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/9055\/revisions"}],"predecessor-version":[{"id":9058,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/9055\/revisions\/9058"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/13527"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=9055"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=9055"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}