Vasoactive-Inotropic Score for the Prediction of Veno-arterial Extracorporeal Membrane Oxygenation after Orthotopic Heart Transplantation

Background: Primary graft failure is still a relevant complication after orthotopic heart transplantation (HTX). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the treatment of choice if the function of the transplanted heart is insufficient despite all conservative measures being exhausted. The “Vasoactive-Inotropic Score” (VIS) quantifies the need for medical circulatory support with the help of ongoing circulatory support drugs and could support the decision-making process for VA-ECMO implantation. Primary hypothesis: The VIS predicts postoperative VA-ECMO implantation after HTX.

Methods: This is a monocentric, retrospective study that included patients who underwent HTX at the University Hospital Düsseldorf in the period 2010–2024 (Ethics Reference No.: 4567). Patients with intraoperative VA-ECMO implantation were excluded. The primary variable analyzed was VIS on arrival at the intensive care unit. The primary endpoint was postoperative VA-ECMO implantation. The VIS is calculated as a weighted sum of all administered inotropes and vasoconstrictors, reflecting pharmacological support of the cardiovascular system. A Receiver Operating Characteristic (ROC) analysis and logistic regression were used as statistical methods.

Results: Out of 329 patient cases in the database, 66 patients (20.0%) were excluded due to intraoperative VA-ECMO implantation, leaving 263 patients (68.8% male, mean age 54.8 ± 10.8 years) for the final analysis. The mean VIS of the overall cohort was 29.9 ± 20.7. The mean VIS for patients with and without postoperative VA-ECMO implantation was significantly different (VA-ECMO: 53.8 ± 38.4 versus no VA-ECMO: 28.6 ± 18.3; p = 0.024). The ROC analysis showed an area under the curve (AUC) of 0.735 (95% confidence interval [95% CI] 0.586–0.884). According to the Youden Index, the cut-off for VIS and VA-ECMO was 42.4. Logistic regression showed a significant association between VIS on arrival in the ICU and postoperative VA-ECMO implantation (odds ratio: 3.203 [95% CI 1.232–8.331]; p = 0.017).

Conclusion: The VIS after HTX on arrival at the ICU shows good discrimination and predicts postoperative implantation of VA-ECMO. The VIS could therefore support clinicians in the decision-making process for VA-ECMO implantation in HTX patients.

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Artikel online veröffentlicht:
11. Februar 2025