Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery

Joseph T. Poterucha, Saraschandra Vallabhajosyula, Alexander Egbe, Joseph S. Krien, Devon O. Aganga, Kimberly Holst, Adele W. Golden, Joseph A. Dearani, Sheri S. Crow

Research output: Contribution to journalArticle

Abstract

Background: High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). Methods: We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity. Results: Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty-two patients (25%), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty-eight patients (15%) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95% CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95% CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4-15.5; P < 0.0001). Conclusions: MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.

Original languageEnglish (US)
JournalCongenital Heart Disease
DOIs
StateAccepted/In press - Jan 1 2018

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Thoracic Surgery
Heart Diseases
Morbidity
Hospital Mortality
Artificial Respiration
Area Under Curve
Intensive Care Units
Pediatrics
Mortality

Keywords

  • adult congenital heart disease
  • cardiac surgery
  • critical care
  • vasoactive

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Poterucha, J. T., Vallabhajosyula, S., Egbe, A., Krien, J. S., Aganga, D. O., Holst, K., ... Crow, S. S. (Accepted/In press). Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery. Congenital Heart Disease. https://doi.org/10.1111/chd.12717

Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery. / Poterucha, Joseph T.; Vallabhajosyula, Saraschandra; Egbe, Alexander; Krien, Joseph S.; Aganga, Devon O.; Holst, Kimberly; Golden, Adele W.; Dearani, Joseph A.; Crow, Sheri S.

In: Congenital Heart Disease, 01.01.2018.

Research output: Contribution to journalArticle

Poterucha, JT, Vallabhajosyula, S, Egbe, A, Krien, JS, Aganga, DO, Holst, K, Golden, AW, Dearani, JA & Crow, SS 2018, 'Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery', Congenital Heart Disease. https://doi.org/10.1111/chd.12717
Poterucha, Joseph T. ; Vallabhajosyula, Saraschandra ; Egbe, Alexander ; Krien, Joseph S. ; Aganga, Devon O. ; Holst, Kimberly ; Golden, Adele W. ; Dearani, Joseph A. ; Crow, Sheri S. / Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery. In: Congenital Heart Disease. 2018.
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abstract = "Background: High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). Methods: We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity. Results: Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4{\%}) met study inclusion criteria. Sixty-two patients (25{\%}), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3{\%})]. Thirty-eight patients (15{\%}) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95{\%} CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95{\%} CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95{\%} CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95{\%} CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95{\%} CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95{\%} CI: 3.4-15.5; P < 0.0001). Conclusions: MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.",
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AU - Poterucha, Joseph T.

AU - Vallabhajosyula, Saraschandra

AU - Egbe, Alexander

AU - Krien, Joseph S.

AU - Aganga, Devon O.

AU - Holst, Kimberly

AU - Golden, Adele W.

AU - Dearani, Joseph A.

AU - Crow, Sheri S.

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N2 - Background: High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). Methods: We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity. Results: Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty-two patients (25%), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty-eight patients (15%) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95% CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95% CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4-15.5; P < 0.0001). Conclusions: MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.

AB - Background: High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). Methods: We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity. Results: Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty-two patients (25%), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty-eight patients (15%) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95% CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95% CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4-15.5; P < 0.0001). Conclusions: MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.

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