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\begin{document}

\title{Vasoplegic Syndrome After Cardiovascular Surgery: A Review of
Pathophysiology and Outcome Oriented Therapeutic Management}



\author[1]{Vishnu Datt}%
\author[1]{Rachna Wadhwa}%
\author[1]{Varun Sharma}%
\author[2]{Sanjula Virmani}%
\author[1]{Harpreet Minhas}%
\author[1]{Shardha Malik}%
\affil[1]{GB Pant Hospital}%
\affil[2]{G B Pant Hospital}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Vasoplegic syndrome (VPS) is defined as systemic hypotension due to
profound vasodilatation and loss of systemic vascular resistance (SVR),
despite normal or increased cardiac index (CI). It occurs in 9- 44\% of
cardiac surgery patients after cardiopulmonary bypass (CPB) and is
associated with significant morbidity and mortality. The pathogenesis of
VPS is multifactorial involving 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; inducible nitric oxide synthase {[}iNOS{]} triggered by
inflammatory cytokines during CPB produces nitric oxide (NO), which
increases vascular levels of cyclic guanosine monophosphate (cGMP),
resulting in vasodilation. leading to postcardiac surgery VPS. Standard
treatment options for severe refractory VPS are extremely limited and
include vasopressor support. latest Surviving Sepsis Campaign guidelines
also consider that the best therapeutic management of vascular hypo-
responsiveness to vasopressors could be a combination of multiple
vasopressors, including norepinephrine (NE) and early prescription of
vasopressin. This review will address the various definitions, risk
factors, pathophysiology, potential cardiac candidates, and potential
therapeutic interventions for VPS following cardiac surgery focussed on
the outcome. This review did not require any ethical approval or consent
from the patients.%
\end{abstract}%



\sloppy


\textbf{Title Page}

\textbf{Title: Vasoplegic Syndrome After Cardiovascular Surgery: A
Review of Pathophysiology and Outcome Oriented Therapeutic Management}

\textbf{Authors:} Vishnu Datt, DA, DNB, MNAMS,1,2,3, Rachna Wadhhwa,
MD1,2, Varun Sharma, MD1,2, Sanjula Virmani, DA, DNB2, HS Minhas, McH3,
Shardha Malik DA, DNB,1,2

\textbf{Affiliation} : Department of Cardiac Anaesthesia and
Cardiothoracic and vascular Surgery, GB Pant Hospital {[}GIPMER{]}, New
Delhi, India

\textbf{Running Title:} Vasoplegic syndrome

\textbf{Sources of Funding:} None

\textbf{conflict of interest:} None

\textbf{Author for Correspondence:}

Dr Vishnu Datt, Director Professor, Cardiac Anaesthesia,

Address:

Room No. 629, Academic Block,

G B Pant hospital {[}GIPMER{]},

JLN Marg, New Delhi-110002

Phone no.99-011- 9718599406

E-mail; dattvishnu@yahoo.com

\par\null

\textbf{Covering letter}

To,

The Editor in chief,

JOCS

Sub: Submission of manuscript for publication.

Respected sir,

We are hereby submitting a manuscript entitled ``\textbf{Vasoplegic
Syndrome After Cardiovascular Surgery: A Review of Pathophysiology and
Outcome Oriented Therapeutic Management}

'' for publication in your journal for a Review. We wish to state that
the manuscript has not been published earlier and is not under
consideration for publication anywhere else. The informed consent was
taken from the parents and that is mentioned in the manuscript.

\textbf{The source of funding and conflict of interest: N} il.

\textbf{Authors with institutional affiliation:}

1. Vishnu Datt, DA, DNB, Director professor, Department of cardiac
Anaesthesia , GB Pant hospital{[}GIPMER{]}, New
Delhi,India{[}\textbf{Corresponding author}{]}

2.Rachna Wadhwa MD, Associate Professor, Department of cardiac
Anaesthesia, GB Pant Hospital {[}GIPMER{]}, new Delhi, India

3.Varun Sharma, MD, DNB Fellow, Department of cardiac Anaesthesia, GB
Pant Hospital {[}GIPMER{]}, New India

4. Sanjula Virmani, DA DNB, Director professor, department of cardiac
Anaesthesia, GB Pant Hospital {[}GIPMER{]}, New Delhi, India

5. HS Minhas McH, Professor, Department of cardio thoracic and vascular
surgery, GB Pant Hospital, {[}GIPMER{]}, New Delhi

6. Shardha DNB, Assistant Professor, Department of cardiac Anaesthesia,
GB Pant Hospital {[}GIPMER{]}, new Delhi, India

\textbf{Institute} ; Department of cardiac Anesthesia and Cardiothoracic
and Vascular surgery, GIPMER, New Delhi. India

Thanks, and Regards.

Yours sincerely,

DR Vishnu Datt \& co-authors

\textbf{Corresponding author's Address.}

Dr Vishnu Datt, Director Professor, Cardiac Anaesthesia,

Room No. 629, Academic Block,

G B Pant hospital, New Delhi-2

\textbf{Phone no.99-011- 9718599406}

\textbf{E-mail; dattvishnu@yahoo.com}

\textbf{Hosted file}

\verb`VPS_Final1.docx`  available at \url{https://authorea.com/users/413861/articles/524973-vasoplegic-syndrome-after-cardiovascular-surgery-a-review-of-pathophysiology-and-outcome-oriented-therapeutic-management}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/vps-pathopysiology-figure/vps-pathopysiology-figure}

\end{center}
\end{figure}

\textbf{Hosted file}

\verb`Fig 2- systematic practical approach.docx`  available at \url{https://authorea.com/users/413861/articles/524973-vasoplegic-syndrome-after-cardiovascular-surgery-a-review-of-pathophysiology-and-outcome-oriented-therapeutic-management}

\textbf{Hosted file}

\verb`table VPS.docx`  available at \url{https://authorea.com/users/413861/articles/524973-vasoplegic-syndrome-after-cardiovascular-surgery-a-review-of-pathophysiology-and-outcome-oriented-therapeutic-management}

\selectlanguage{english}
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\end{document}

