Maximum Vasoactive Inotropic Score in the 48 Hours Post-LVAD Implantation Predicts 90 Day Mortality.

The vasoactive inotropic score (VIS) is an emerging method to estimate total inotropic and vasopressor support after cardiothoracic surgery. Whether the post-operative VIS score can predict mortality in patients following LVAD implantation is unknown. We performed a single-center retrospective study of 268 patients who received a continuous-flow durable LVAD between Jan 1, 2006 and Dec 31, 2017. The VIS score was calculated as: dobutamine (mcg/kg/min) + 10 x milrinone (mcg/kg/min) + dopamine (mcg/kg/min) + 100 x epinephrine (mcg/kg/min) + 100 x norepinephrine (mcg/kg/min) + 10,000 x vasopressin (units/kg/min). The VIS score at 6, 24, and 48 hours postoperatively were abstracted and then the maximum VIS score within 48 hours after implantation for each patient was used to stratify the cohort into quartiles. Kaplan-Meier method was used to estimate 90-day survival and Cox Hazard model was performed to evaluate for predictors of 90-day mortality. The VIS quartiles groups were 0-9, 10-16, 17-23, and 24-87. Patients in quartile 4 were older and had a higher preoperative right atrial pressure (Table 1). VIS quartiles demonstrate a stepwise increase in adjusted hazard ratio compared to the 1st quartile in our multivariable model (which included age, total bilirubin over 2.5, gender, and VIS) with VIS quartile 2 HR 2.45 (95% CI 0.65 - 9.24, p = 0.18), VIS quartile 3 HR 3.39 (95% CI 0.90 - 12.79, p = 0.07), VIS quartile 4 HR 4.53 (95% CI 1.28 - 16.05, p = 0.02). Figure 1 demonstrates worsened survival by VIS quartiles up to 90-days post LVAD implantation (logrank test p=0.048). Elevated VIS score within the first 48 hours after LVAD implantation correlates with an increased risk of mortality at 90 days. Further work is needed to confirm this relationship. [ABSTRACT FROM AUTHOR]