Prognostic value of vasoactive-inotropic score following continuous flow left ventricular assist device implantation

Jiho Han, Alberto Pinsino, Joseph Sanchez, Hiroo Takayama, A. Reshad Garan, Veli K. Topkara, Yoshifumi Naka, Ryan T. Demmer, Paul A. Kurlansky, Paolo C. Colombo, Koji Takeda, Melana Yuzefpolskaya

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

BACKGROUND: The purpose of this study is to evaluate the utility of vasoactive-inotropic score (VIS) in predicting outcomes after left ventricular assist device (LVAD) implantation and explore possible mechanisms of post-operative hemodynamic instability. METHODS: Retrospective review was performed in 418 consecutive patients with LVAD implantation. VIS was calculated as dopamine + dobutamine + 10 × milrinone + 100 × epinephrine + 100 × norepinephrine (all μg/kg/min) + 10000 × vasopressin (U/kg/min) after initial stabilization in the operating room and upon arrival at the intensive care unit. The primary outcome was in-hospital mortality. The secondary outcomes were a composite of in-hospital mortality, delayed right ventricular assist device (RVAD) implantation, and continuous renal replacement therapy. The pre-operative biomarkers of inflammation, oxidative stress, endotoxemia and gut-derived metabolite trimethylamine-N-oxide (TMAO) were measured in a subset of 61 patients. RESULTS: Median VIS was 20.0 (interquartile range 13.3–27.9). VIS was an independent predictor of in-hospital mortality (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03–1.09, p < 0.001) and composite outcome (OR 1.03, 95% CI 1.01–1.06, p = 0.008). In-hospital mortality increased for each VIS quartile (0% vs 3.9% vs 7.6% vs 12.3%, p = 0.002). VIS was superior to other established LVAD risk models as a predictor of in-hospital mortality (area under the curve 0.73, 95% CI 0.64–0.82). The optimal cut-off point for VIS as a predictor of in-hospital mortality was 20. Pre-operative hemoglobin level was the only independent predictor of VIS ≥ 20 (p = 0.003). Patients with a high VIS were more likely to have elevated TMAO pre-operatively (53.6% vs 25.8%, p = 0.03). CONCLUSIONS: A high post-operative VIS is associated with adverse in-hospital outcomes and is a better predictor of in-hospital mortality compared with existing LVAD risk models. Whether early hemodynamic stabilization using RVAD may benefit patients with a high VIS remains to be investigated.

Original languageEnglish (US)
Pages (from-to)930-938
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume38
Issue number9
DOIs
StatePublished - Sep 2019

Keywords

  • in-hospital mortality
  • inotropes
  • trimethylamine-N-oxide
  • vasopressors
  • ventricular assist device

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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