title: Vasoactive-inotropic score after pediatric heart transplant: a marker of adverse outcome.
abstract: VIS, a quantitative index of pressor support, has been shown to be a predictor of morbidity and mortality in infants younger than six months who underwent CPB. Data on its prognostic utility following pediatric OHT are lacking. This study compared clinical outcomes in children with differential VIS after pediatric OHT. A retrospective cohort study of 51 consecutive heart transplants from 2004 to 2011 was performed at a pediatric tertiary care facility. Peak VIS was computed within initial 24 and 48 h after OHT and was weighted for peak dose and administration of any or all of six pressors. Patients with peak VIS ≥ 15 constituted high VIS group. Children who persistently required a higher magnitude of pressor support for the first 48 h after OHT, as reflected by high peak VIS, had significantly longer ICU stay (30.2 vs. 15.9 days, p = 0.01), pressor (11.4 vs. 6.8 days, p = 0.02) and ventilatory durations (12.4 vs. 5.9 days, p = 0.05), and higher rates of short-term morbidities. Patients with longer CPB (213 vs. 153 min, p = 0.005) time have higher peak VIS. High peak VIS at 48 h is an effective, yet simple clinical marker for adverse outcomes in pediatric OHT recipients.
authors.affiliation: Division of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA. ysanil@dmc.org
authors.forename: Yamuna
authors.initials: Y
authors.lastname: Sanil
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods* / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents
keywords: cardiac surgery; congenital heart disease; pediatric heart transplant; postoperative outcome; vasoactive-inotropic score