Objective: Determine if prophylactic tocilizumab reduces the incidence of vasoplegic syndrome (VS) in patients undergoing left ventricular assist device (LVAD) implantation. Background: Vasoplegic syndrome is a life-threatening complication that occurs in 5% to 25% of patients undergoing cardiothoracic surgery with a mortality rate as high as 25%. Vasoplegic syndrome is characterized by profound systemic hypotension with normal to high cardiac output, requiring treatments such as vasopressors, nitric oxide modulators, (e.g. methylene blue and hydroxocobalamin) and other rescue medications such as angiotensin II. Recent case studies have suggested that tocilizumab may prevent vasodilatory syndromes, including VS. Tocilizumab’s antagonism of interleukin-6 may prevent the vasodilatory response by reducing the body’s cytokine production and inflammatory response. This mechanism may be able to reduce the sterile inflammatory response that is thought to cause VS. Methodology: This was a retrospective chart review study of adult patients who underwent LVAD implantation at Piedmont Atlanta Hospital between January 2020 and December 2025. Patients were excluded from the study if they had received tocilizumab for alternative indications or had a SARS-CoV-2 infection within 10 days of surgery. The primary outcome of the study was to compare the incidence of VS between those who did and did not receive tocilizumab. Secondary outcomes included adverse drug events attributed to tocilizumab, vasoactive-inotropic score (VIS) at 6 and 24 hours, mortality at 48 hours and 28 days, the need for rescue medications use, infection within 28 days of surgery, the duration of mechanical ventilation, intensive care unit (ICU) length of stay, and mechanical circulatory support post-surgery. Statistical analysis was completed using chi-squared test or Fischer’s exact test. A p-value of < 0.05 was considered statistically significant. Results: The assessed cohort included 82 patients in the control group and 41 patients in the experimental group. All patients were included in the statistical analysis. When comparing prophylactic tocilizumab to the control group, there was found to be no difference in incidence of VS (26.8% vs 15.9%; p=0.1476. No statistical significance was found between rate of infection (26.8% vs 21.9%; p=0.548), mortality at 48 hours (0% vs 0%; p=0), mortality at 28 days (10% vs 9.8%; p=0.2509), and the use of rescue medications (14.6% vs 9.8%; p=0.1661). There was a significant difference when comparing VIS scores at 6 hours (15; 95% CI 11-21.48 vs 11.96; CI 8.5-17.12, p=0.0098) and at 24 hours (12.33; CI 9.5-15.29 vs 9.25; CI 7.5-15.75). Conclusions: There was no statistically significant difference seen in the primary outcome of incidence of VS when using prophylactic tocilizumab. There were no statistically significant differences noted in any secondary endpoints, except that tocilizumab may worsen the VIS score at 6 and 24-hours post-surgery and prolong times on the ventilator. Study limitations included the retrospective and small patient population. Prospective trials with a larger sample size are warranted in this population.
