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Vasoactive-ventilation-renal score: a reliable prognostic index for perioperative outcomes following congenital heart surgery in adults

Published online by Cambridge University Press:  17 December 2020

Diana M. Torpoco Rivera Open the ORCID record for Diana M. Torpoco Rivera [Opens in a new window] ,
Richard U. Garcia  and
Sanjeev Aggarwal
Diana M. Torpoco Rivera*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
Richard U. Garcia
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
Sanjeev Aggarwal
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
*
Author for correspondence: Dr D. M. Torpoco Rivera, MD, Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA. Tel: +1 313 919 8945. E-mail: [email protected]
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Abstract

Introduction:

The number of adults requiring surgeries for CHD is increasing. We sought to evaluate the utility of the vasoactive-ventilation-renal (VVR) score as a predictor of prolonged length of stay in adults following CHD surgery.

Methods:

This is a retrospective review of 158 adult patients who underwent CHD surgery involving cardiopulmonary bypass. VVR score was calculated upon arrival to ICU and every 6 hours for the first 48 hours post-operatively. Our primary outcome was prolonged length of stay defined as hospital length of stay greater than 75th percentile for the cohort (≥8 days).

Results:

The study cohort had a median age of 25.6 years (18–60 years), and 83 (52.5%) were male. The groups with and without prolonged length of stay were comparable in age, gender, race, and surgical severity score. VVR score was significantly higher at all time points in the group with prolonged length of stay. The first post-operative day peak VVR score ≥13 had a sensitivity of 81% and specificity of 75% for predicting prolonged length of stay (p = 0.0001). On regression analysis, peak VVR score during the first day was independently associated with prolonged length of stay.

Conclusions:

Peak VVR score during the first post-operative day was a strong predictor of prolonged length of stay in adults following CHD surgery.

Keywords

CHDadultsvasoactive-ventilation-renal scoreprolong length of stay
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 5 , May 2021 , pp. 762 - 768
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Marelli, AJ, Ionescu-Ittu, R, Mackie, AS, et al. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014; 130: 749–756.CrossRefGoogle ScholarPubMed
Van der Bom, T, Bouma, BJ, Meijboom, FJ, et al. The prevalence of adult congenital heart disease, results from a systematic review and evidence based calculation. Am Heart J 2012; 164: 568–575.CrossRefGoogle ScholarPubMed
Warnes, CA, Liberthson, R, Danielson, GK, et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001; 37: 1170–1175.CrossRefGoogle ScholarPubMed
Agarwal, S, Sud, K, Menon, V. Nationwide hospitalization trends in adult congenital heart disease across 2003–2012. J Am Heart Assoc 2016; 5: e002330.CrossRefGoogle ScholarPubMed
Jacobs, JP, Mavroudis, C, Quintessenza, JA, et al. Reoperations for pediatric and congenital heart disease: an analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17: 2–8.CrossRefGoogle Scholar
Zomer, AC, Verheugt, CL, Vaartjes, I, et al. Surgery in adults with congenital heart disease. Circulation 2011; 124: 2195–2201.CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-Inotropic Score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
Gaies, MG, Jeffries, HE, Niebler, RA, et al. Vasoactive-Inotropic Score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med 2014; 15: 529–537.CrossRefGoogle ScholarPubMed
Garcia, RU, Walters, HL, 3rd, Delius, RE, et al. Vasoactive Inotropic Score (VIS) as biomarker of short-term outcomes in adolescents after cardiothoracic surgery. Pediatr Cardiol 2016; 37: 271–277.CrossRefGoogle ScholarPubMed
Miletic, KG, Spiering, TJ, Delius, RE, et al. Use of a novel vasoactive-ventilation-renal score to predict outcomes after paediatric cardiac surgery. Interact Cardiovasc Thorac Surg 2015; 20: 289–295.CrossRefGoogle ScholarPubMed
Miletic, KG, Delius, RE, Walters, HL, 3rd, et al. Prospective validation of a novel vasoactive-ventilation-renal score as a predictor of outcomes after pediatric cardiac surgery. Ann Thorac Surg 2016; 101: 1558–1563.CrossRefGoogle ScholarPubMed
Scherer, B, Moser, EA, Brown, JW, et al. Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2016; 152: 1423–1429.CrossRefGoogle ScholarPubMed
O’Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 1139–1153.CrossRefGoogle ScholarPubMed
DeLong, ER, DeLong, DM, Clarke-Pearson, DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837–845.10.2307/2531595CrossRefGoogle ScholarPubMed
Yamazaki, Y, Oba, K, Matsui, Y, et al. Vasoactive-Inotropic Score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth 2018; 32: 167–173.CrossRefGoogle ScholarPubMed
Alam, S, Akunuri, S, Jain, A, Mazahir, R, Hegde, R. Vasoactive-ventilation-renal score in predicting outcome postcardiac surgery in children. Int J Crit Illn Inj Sci 2018; 8: 143–148.Google ScholarPubMed
Mahan, VL, Gupta, M, Aronoff, S, Bruni, D, Stevens, RM, Moulick, A. Vasoactive-ventilation-renal score predicts cardiac care unit length of stay in patients undergoing re-entry sternotomy: a derivation study. World J Cardiovasc Surg 2018; 8: 7–21.CrossRefGoogle Scholar
Kumar, M, Sharma, R, Sethi, SK, et al. Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery. Indian J Crit Care Med 2014; 18: 653–658.Google ScholarPubMed
Kozlik-Feldmann, R, Kramer, HH, Wicht, H, et al. Distribution of myocardial beta-adrenoceptor subtypes and coupling to the adenylate cyclase in children with congenital heart disease and implications for treatment. J Clin Pharmacol 1993; 33: 588–595.CrossRefGoogle ScholarPubMed
Shahin, J, DeVarennes, B, Tse, CW, et al. The relationship between inotrope exposure, six-hour postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery. Crit Care 2011; 15: R162.CrossRefGoogle ScholarPubMed
Ozturk, E, Tanidir, IC, Güneş, M, et al. The effect of Vasoactive-ventilation-renal score on pediatric heart surgery. North Clin İstanb 2020; 7: 329–334.Google Scholar