Association between vasoactive-inotropic score, morbidity and mortality after heart transplantation

Joanna Tohme; Mickael Lescroart; Jérémie Guillemin; Pascal Orer; Pauline Dureau; Shaida Varnous; Pascal Leprince; Guillaume Coutance; Adrien Bouglé

doi:10.1093/icvts/ivad055

Association between vasoactive-inotropic score, morbidity and mortality after heart transplantation

Interdiscip Cardiovasc Thorac Surg. 2023 Apr 3;36(4):ivad055. doi: 10.1093/icvts/ivad055.

Authors

Joanna Tohme¹, Mickael Lescroart², Jérémie Guillemin¹, Pascal Orer¹, Pauline Dureau¹, Shaida Varnous², Pascal Leprince², Guillaume Coutance², Adrien Bouglé¹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
² Department of Thoracic and Cardiovascular Surgery, Cardiology Institute, Sorbonne University, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.

Abstract

Objectives: The aim of this study was to evaluate the association between vasoactive-inotropic score (VIS), calculated in the 24 h after heart transplantation, and post-transplant mortality and morbidity.

Methods: This was an observational single-centre retrospective study. Patients admitted to surgical intensive care unit after transplantation, between January 2015 and December 2018, were reviewed consecutively. VISmax was calculated as dopamine+ dobutamine+ 100 × epinephrine + 100 × norepinephrine + 50 × levosimendan + 10 × milrinone (all in µg/kg/min) + 10 000 × vasopressin (units/kg/min), using the maximum dosing rates of vasoactive and inotropic medications in the 24 h after intensive care unit admission. The primary outcome was mortality at 1 year post-transplant. The secondary outcomes included length of stay, duration of mechanical ventilation and inotropic support and the occurrence of septic shock, ventilator-associated pneumonia, bloodstream infection or renal replacement therapy.

Results: A total of 151 patients underwent heart transplantation and admitted to intensive care unit. The median VISmax was 39.2 (interquartile range = 19.4-83.0). VISmax was independently associated with 1-year post-transplant mortality, as well as recipient age [hazard ratio (HR) = 1.004, P-value = 0.013], recipient gender (female to male: hazard ratio = 2.23, P-value = 0.047) and combined transplantation (hazard ratio = 2.85, P-value = 0.048). There was a significant association between VISmax and duration of mechanical ventilation (P-value < 0.001), length of stay (P-value = 0.002), duration of infused inotropes (P-value < 0.001), occurrence of bloodstream infections, septic shocks, ventilation-acquired pneumonia and renal replacement therapy.

Conclusions: VISmax calculated during the first 24 h after postoperative intensive care unit admission in transplanted patients is independently associated with 1-year mortality. In addition, length of stay, duration of mechanical ventilation and infused inotropes increased with increasing VISmax.

Keywords: Heart transplantation; Mortality; Primary graft dysfunction; Prognostic score; Vasoactive–inotropic score.