ABSTRACT: INTRODUCTION: Post cardiac surgery vasodilatation is possibly related to a vasopressin deficiency that could be related to a chronic stimulation of the adeno-hypophysis. To assess vasopressin system activation, perioperative course of copeptin and vasopressin plasma concentrations have been studied in consecutive patients operated on cardiac surgery. METHODS: 64 consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass were studied. Haemodynamic, laboratory and clinical data were recorded before and during cardiopulmonary bypass, and at the 8th post-operative hour (H8). At the same time, point's blood was withdrawn to determine plasma concentrations of arginine-vasopressin (AVP, radioimmunoassay) and copeptin (immunoluminometric assay). Post cardiac surgery vasodilation (PCSV) was defined as a mean arterial blood pressure less than 60 mmHg with a cardiac index [equal to or greater than] 2.2 L * min^-1 * m^-2, and was treated with norepinephrine (NE) in order to restore a mean blood pressure > 60 mmHg. Patients with PCSV were compared to the other patients (controls). Student's t, Fisher's exact test, or non parametric tests (Mann Whitney, Wilkoxon) were used when appropriate. A correlation between AVP and copeptin has been evaluated and a receiver-operator characteristic (ROC) analysis was calculated to assess the utility of preoperative copeptin to distinguish between controls and PCSV patients. RESULTS: Patients who experienced a PCSV have significantly higher copeptin plasma concentration before cardiopulmonary bypass (P <0.001) but lower AVP concentrations at H8 (P <0.01) than controls. PCSV patients had preoperative hyponatremia and decreased left ventricle ejection fraction, and experienced more complex surgery (redo). The area under the ROC curve of preoperative copeptin concentration was 0.86[plus/minus]0.04 [95%CI: 0.78-0.94] (P <0.001). The best predictive value for preoperative copeptin plasma concentration was 9.43 pmol/L with a sensitivity of 90% and a specificity of 77%. CONCLUSIONS: High preoperative copeptin plasma concentration is predictive of PSCV and suggests an activation of the AVP system before surgery that may facilitate depletion of endogenous AVP stores and a relative AVP deficit after surgery.