@Article{chd.12717,
AUTHOR = {Joseph T. Poterucha, Saraschandra Vallabhajosyula, Alexander C. Egbe, Joseph S. Krien, Devon O. Aganga, Kimberly Holst, Adele W. Golden, Joseph A. Dearani, Sheri S. Crow},
TITLE = {Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {2},
PAGES = {193--200},
URL = {http://www.techscience.com/schd/v14n2/38767},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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).<br/>
<b>Methods:</b> 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 admis‐
sion were examined to determine the relationship between VIS score and poor out‐
come of early mortality, early morbidity, or complication related morbidity.<br/>
<b>Results:</b> Overall, 1040 ACHD patients had cardiac surgery during the study time
frame; 243 (23.4%) met study inclusion criteria. Sixty‐two patients (25%), experi‐
enced composite poor outcome [including eight deaths within 90 days of hospital 
discharge (3%)]. Thirty‐eight patients (15%) endured complication related early mor‐
bidity. 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 compos‐
ite 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).<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12717}
}