Journal of Anesthesia

, Volume 32, Issue 2, pp 167–173 | Cite as

Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass

  • Yumiko Yamazaki
  • Koji Oba
  • Yoshiro Matsui
  • Yuji Morimoto
Original Article



The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery.


A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed “poor outcome”, which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation.


After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51–18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10–2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28–2.74, p = 0.001).


The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.


Vasoactive-inotropic score Cardiac surgery Prediction Morbidity Mortality 


Author contributions

YY: this author designed, analyzed, and prepared manuscript. KO: this author helped to design the study and analyzed data. YM: this author helped to prepare manuscript. YM: this author helped to conduct the study and prepare manuscript.

Supplementary material

540_2018_2447_MOESM1_ESM.jpg (19 kb)
Supplement Figure 1. Receiver operating characteristic curve of vasoactive inotropic score. The area under the receiver operating curve was 0.77 and the optimal cutoff point of the VIS to determine the high and low VIS groups was 5.5, with sensitivity of 0.83 and specificity of 0.54. AUC, area under the curve (JPEG 19 kb)


  1. 1.
    Ettema RGA, Peelen LM, Schuurmans MJ, Nierich AP, Kalkman CJ, Moons KGM. Prediction models for prolonged intensive care stay after cardiac surgery: systematic review and validation study. Circulation. 2010;122:682–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Granton J, Cheng D. Risk stratification models for cardiac surgery. Semin Cardiothorac Vasc Anesth. 2008;12:167–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Cislaghi F, Condemi AM, Corona A. Predictors of prolonged ventilation in a cohort of 5123 cardiac surgical patients. Eur J Anaesthesiol. 2009;26:396–403.CrossRefPubMedGoogle Scholar
  4. 4.
    Anderson AJ, Barros Neto FX, Costa Mde A, Dantas LD, Hueb AC, Prata MF. Predictors of mortality in patients over 70-year-old undergoing CABG or valve surgery with cardiopulmonary bypass. Rev Bras Cir Cardiovasc. 2011;26:69–75.CrossRefPubMedGoogle Scholar
  5. 5.
    Widyastuti Y, Stenseth R, Pleym H, Wahba A, Videm V. Pre-operative and intraoperative determinants for prolonged ventilation following adult cardiac surgery. Acta Anaesthesiol Scand. 2012;56:190–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Widyastuti Y, Stenseth R, Berg KS, Pleym H, Wahba A, Videm V. Preoperative and intraoperative prediction of risk of cardiac dysfunction following open heart surgery. Eur J Anaesthesiol. 2012;29:143–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Parolari A, Pesce LL, Pacini D, Mazzanti V, Salis S, Sciacovelli C, Rossi F, Alamanni F, Monzino Research Group on Cardiac Surgery Outcomes. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. Ann Thorac Surg. 2012;93:584–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, Charpie JR, Hirsch JC. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11:234–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, Walsh AZ, Chang RN, Anthony C, Castaneda AR, Newburger JW, Wessel DL. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92:2226–35.CrossRefPubMedGoogle Scholar
  10. 10.
    Basaran M, Sever K, Kafali E, Ugurlucan M, Sayin OA, Tansel T, Alpagut U, Dayioglu E, Onursal E. Serum lactate level has prognostic significance after pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2006;20:43–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Gruenwald CE, McCrindle BW, Crawford-Lean L, Holtby H, Parshuram C, Massicotte P, Van Arsdell G. Reconstituted fresh whole blood improves clinical outcomes compared with stored component blood therapy for neonates undergoing cardiopulmonary bypass for cardiac surgery: a randomized controlled trial. J Thorac Cardiovasc Surg. 2008;136:1442–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Kulik TJ, Moler FW, Palmisano JM, Custer JR, Mosca RS, Bove EL, Bartlett RH. Outcome-associated factors in pediatric patients treated with extracorporeal membrane oxygenator after cardiac surgery. Circulation. 1996;94:II63–8.Google Scholar
  13. 13.
    Rhodes JF, Blaufox AD, Seiden HS, Asnes JD, Gross RP, Rhodes JP, Griepp RB, Rossi AF. Cardiac arrest in infants after congenital heart surgery. Circulation. 1999;100:II194–9.Google Scholar
  14. 14.
    Shahin J, Devarennes B, Tse CW, Amarica DA, Dial S. The relationship between inotrope exposure, 6-h postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery. Crit Care. 2011;15:R162.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A. Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome: propensity-adjusted analyses. Anesthesiology. 2008;108:979–87.CrossRefPubMedGoogle Scholar
  16. 16.
    Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15:816–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989;79:I3–12.PubMedGoogle Scholar
  18. 18.
    Motomura N, Miyata H, Tsukihara H, Takamoto S, Japan Cardiovascular Surgery Database Organization. Risk model of valve surgery in Japan using the Japan adult cardiovascular surgery database. J Heart Valve Dis. 2010;19:684–91.PubMedGoogle Scholar
  19. 19.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Srisawat N, Hoste EE, Kellum JA. Modern classification of acute kidney injury. Blood Purif. 2010;29:300–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Englberger L, Suri RM, Li Z, Casey ET, Daly RC, Dearani JA, Schaff HV. Clinical accuracy of RIFLE and acute kidney injury network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care. 2011;15:R16.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Royster RL, Butterworth JF 4th, Prough DS, Johnston WE, Thomas JL, Hogan PE, Case LD, Gravlee GP. Preoperative and intraoperative predictors of inotropic support and long-term outcome in patients having coronary artery bypass grafting. Anesth Analg. 1991;72:729–36.CrossRefPubMedGoogle Scholar
  23. 23.
    Butterworth JF 4th, Legault C, Royster RL, Hammon JW Jr. Factors that predict the use of positive inotropic drug support after cardiac valve surgery. Anesth Analg. 1998;86:461–7.CrossRefPubMedGoogle Scholar
  24. 24.
    McKinlay KH, Schinderle DB, Swaminathan M, Podgoreanu MV, Milano CA, Messier RH, El-Moalem H, Newman MF, Clements FM, Mathew JP. Predictors of inotrope use during separation from cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2004;18:404–8.CrossRefPubMedGoogle Scholar
  25. 25.
    De Cocker J, Messaoudi N, Stockman BA, Bossaert LL, Rodrigus IE. Preoperative prediction of intensive care unit stay following cardiac surgery. Eur J Cardiothorac Surg. 2011;39:60–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Schwann NM, Hillel Z, Hoeft A, Barash P, Möhnle P, Miao Y, Mangano DT. Lack of effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg. 2011;113:994–1002.CrossRefPubMedGoogle Scholar
  27. 27.
    Pölönen P, Ruokonen E, Hippeläinen M, Pöyhönen M, Takala J. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg. 2000;90:1052–9.CrossRefPubMedGoogle Scholar
  28. 28.
    St André AC, DelRossi A. Hemodynamic management of patients in the first 24 hours after cardiac surgery. Crit Care Med. 2005;33:2082–93.CrossRefPubMedGoogle Scholar
  29. 29.
    Fujishima K, Yamamoto A, Hachisu M. Effects of amrinone on renal flow and cardiac function, in comparison with those of milrinone and olprinone, in anesthetized dog. Nihon Yakurigaku Zasshi. 1998;112(6):371–80.CrossRefPubMedGoogle Scholar
  30. 30.
    Kimata S, Kasanuki H, Hirosawa H, Takano A, Serizawa T, Shinoyama S, Kumada T, Hori M, Hiramori K. Clinical assessment of E-1020 in acute heart failure—optimal dose assessment (in Japanese). Jpn J Clin Exp Med. 1992;69:3984–96.Google Scholar
  31. 31.
    Sha K, Shimokawa M, Ishimaru K, Kawaraguchi Y, Takahashi M, Yanaidani F, Kitaguchi K, Furuya H. Differences in hemodynamic effects of amrinone, milrinone and olprinone after cardiopulmonary bypass in valvular cardiac surgery. Masui. 2000;49(9):981–6.PubMedGoogle Scholar
  32. 32.
    Heart Failure Society of America. HFSA 2006 comprehensive heart failure guideline. J Card Fail. 2006;12:el–122.Google Scholar
  33. 33.
    Kozlik-Feldmann R, Kramer HH, Wicht H, Feldmann R, Netz H, Reinhardt D. Distribution of myocardial beta-adrenoceptor subtypes and coupling to the adenylate cyclase in children with congenital heart disease and implication for treatment. J Clin Pharmacol. 1993;33(7):588–95.CrossRefPubMedGoogle Scholar
  34. 34.
    Gillies M, Bellomo R, Doolan L, Buxton B. Bench-to-bedside review: inotropic drug therapy after adult cardiac surgery: a systematic literature review. Crit Care. 2005;9:266–79.CrossRefPubMedGoogle Scholar
  35. 35.
    Mebazaa A, Parissis J, Porcher R, Gayat E, Nikolaou M, Boas FV, Delgado JF, Follath F. Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods. Intensive Care Med. 2011;37:290–301.CrossRefPubMedGoogle Scholar
  36. 36.
    American Society of Anesthesiologists Task Force on Pulmonary. Artery catheterization. Practice guidelines for pulmonary artery catheterization: an updated report by the American Society of Anesthesiologists Task Force on pulmonary artery catheterization. Anesthesiology. 2003;99:775–6.CrossRefGoogle Scholar
  37. 37.
    Jacka MJ, Cohen MM, To T, Devitt JH, Byrick R. The appropriateness of the pulmonary artery catheter in cardiovascular surgery. Can J Anaesth. 2002;49:276–82.CrossRefPubMedGoogle Scholar
  38. 38.
    Jacka MJ, Cohen MM, To T, Devitt JH, Byrick R. The use of and preferences for the transesophageal echocardiogram and pulmonary artery catheter among cardiovascular anesthesiologists. Anesth Analg. 2002;94:1065–71.CrossRefPubMedGoogle Scholar
  39. 39.
    Giglio M, Dalfino L, Puntillo F, Rubino G, Marucci M, Brienza N. Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2012;15(5):878–87.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Anesthesiology and Critical Care MedicineHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Biostatistics, School of Public Health, Graduate School of MedicineThe University of TokyoTokyoJapan
  3. 3.Cardiovascular and Thoracic SurgeryHokkaido University Graduate School of MedicineSapporoJapan

Personalised recommendations