Early-Stage Vasoactive-Inotropic Score and Left Ventricular Ejection Fraction Following Cardiac Surgery: A Comparison of Two Non-invasive Heart Function Monitoring Technologies in the Prognosis of Infants

Abstract

Objectives: This study aimed to compare the efficiencies of the vasoactive-inotropic score (VIS) and left ventricular ejection fraction (LVEF) in predicting the condition and prognosis of children with congenital heart disease (CHD). Methods: We retrospectively reviewed the medical charts of 104 infants aged < 1 year who underwent cardiac surgery with cardiopulmonary bypass. The maximum and mean postoperative VIS in the first and second 24 hours [VIS (24MAX), VIS (24MEA), VIS (48MAX), and VIS (48MEA)] were recorded. Similarly, LVEF within 24 hours following surgery was monitored. Receiver operator curve (ROC), regression analysis, chi-square test, and t-test were used to analyze both heart function monitoring technologies Results: Receiver operating characteristic analysis revealed that VIS was strongly associated with adverse events and death [area under ROC (AUROC) > 0.90, P = 0.00], with the two most representative scores being VIS (24MEA) and VIS (48MAX), with cut-off points of 19.42 (sensitivity = 100%; specificity = 93.90%) and 22 (sensitivity = 100%; specificity = 93.90%), respectively for death, and 18.02 (sensitivity = 91.70%; specificity = 89.10%) and 17.75 (sensitivity = 91.70%; specificity = 90.20%), respectively for adverse events. Infants with higher VIS had significantly higher mortality, higher incidence of clinical adverse events, higher lactic acid value, and longer mechanical ventilation and ICU stay (P < 0.05). However, LVEF within 24 hours following surgery was not associated with death (AUROC = 0.65, P = 0.33) or adverse events (AUROC = 0.53, P = 0.81). Moreover, there was no significant change in the length of ICU stay, duration of mechanical ventilation, and lactate value (P > 0.05). Conclusions: Vasoactive-inotropic score at an early stage following surgery was significantly associated with the condition and prognosis of infants with congenital heart disease; however, the predictive value of LVEF within 24 hours following surgery was lower.