Evaluation of the Superiority of VAsopressin Versus NOradrenaline in the Management of Patients at Risk of Kidney Failure Undergoing Cardiac Surgery With Extracorporeal Circulation

Inclusion criteria

• Patient who has given free, written and informed consent
• Patient of legal age.
• Negative pregnancy test for women of childbearing age
• Patient requiring cardiac surgery:

• Scheduled (> 24h)
• With extracorporeal circulation (ECC)
• Myocardial revascularization (coronary bypass), and/or surgical correction of valvulopathy (aortic, mitral, pulmonary, tricupsidian), and/or of the ascending aorta and/or removal of an intracardiac tumor, and/or closure of a PFO/ASD
• Patient with at least 3 risk factors for acute kidney failure including:

• age > 70 years, combined surgery (more than two procedures), common trunk lesion, preoperative anemia, chronic respiratory failure, obliterative arterial disease of the lower extremities, diabetes, glomerular filtration < 60 ml min-1 m², LVEF <40%, redux, intra-aortic counterpulsation balloon, expected duration of bypass surgery > 100 min, albuminuria

Exclusion criteria

• Patient not affiliated to national health insurance or not beneficiary of a social security system,
• Patient subject to a measure of legal protection (curatorship, guardianship),
• Pregnant, parturient or breastfeeding women,
• Patients of legal age who are incapable or unable to express their consent,
• Patients who have already been included in this study
• Patients requiring emergency surgery (less than 24 hours)
• Patient with chronic kidney failure on dialysis,
• Patient with a cardiac transplant,
• Patient on left-sided monoventricular assistance,
• Patient on ECMO/ECLS,
• Patient with acute circulatory failure in the immediate preoperative period (sepsis, hemorrhage),
• Patients with known hypersensitivity to the active ingredient (argipressin) or to one of the excipients of REVERPLEG®.

Secondary exclusion criteria:

• Patient not developing persistent arterial hypotension (vasoplegic syndrome), within 12 hours after completion of surgery, defined as persistent mean arterial pressure (MAP) <65 mmHg despite correction of preload and inotropism, with a cardiac index >2.2 l min-1 m-2, and not responding to 30 mg cumulative of ephedrine in bolus
• Patient with hemorrhagic shock perioperatively before receiving vasopressor therapy (treatment under study)