Increased Vasoactive Inotrope Score Following Left Ventricular Assist Device Placement Is Associated With Increased Mortality And Early Right Ventricular Failure

Background The vasoactive inotrope score (VIS) has been used as a model to predict mortality and adverse events following left ventricular assist device (LVAD) implantation. We attempt to validate the previously reported association between elevated VIS and increased long-term mortality and assess if elevated VIS and other hemodynamic parameters increase the odds of right ventricular failure (RVF) within 30 days of LVAD implantation. Hypothesis Increased VIS following LVAD implantation will increase mortality and odds of developing RVF. Methods A single-center retrospective chart review was conducted for 235 patients with LVAD implantation and complete post-operative management from 2006-2016. The VIS was calculated as 100 x epinephrine + 100 x norepinephrine + 10 x milrinone + dopamine + dobutamine (μg/kg/min) + 1000 x vasopressin (U/kg/min) and was collected at 6, 24, and 48-hour intervals post-implantation. Patients were stratified by a maximum VIS score of 20 and compared via baseline demographics and comorbidities. Results The average maximum VIS for all patients was 15.38 (± 8.77). Those with a VIS ≥20 had a greater proportion of males (p = 0.046) and a history of obstructive sleep apnea (p = 0.002), MI (p = 0.005), CABG (p = 0.001), PCI (p = 0.007), and ICD placement (p = 0.003). (Table 1). Survival analysis found that VIS ≥ 20 was associated with increased 1-year mortality (HR 2.08, 95% CI [1.20- 3.31], p = 0.009) (Figure 1). In our multivariable logistic regression model a VIS ≥ 20 (OR 2.79, 95% CI [1.34- 5.79], p = 0.006) and a CVP/ PCWP \u003e0.6 (OR 2.26, 95% CI [1.08- 4.73], p = 0.030) significantly increased the odds of early RVF. Conclusion Elevated VIS score in the first 48 hours following LVAD implantation is associated with an increased risk of mortality. Elevated VIS and CVP/PCWP \u003e0.6 also increase the odds of early RVF. Further research with larger cohorts is needed to validate these findings as they could have significant implications on perioperative LVAD management.