The effects of Vasoactive-Ventilation-Renal score on pediatric heart surgery

OBJECTIVE: The effects of Vasoactive-Ventilation-Renal (VVR) score on the evaluation of pediatric heart surgery results were investigated in this study.
METHODS: This retrospective study included children younger than 18 years of age who were operated for congenital heart disease between was July 1st- December 31st 2018. Patients who needed ECMO support at the first postoperative 72 hours were not included in the study group. The postoperative initial, 24th and 48th-hour Vasoactive-Inotrope Score (VIS) and VVR scores of all patients were calculated in the intensive care unit (ICU). The effects of these scores on lengthy ICU duration (PCILOS, duration more than the upper 25th percentile) and to the hospital mortality (before 30 days) were evaluated.
RESULTS: There were 340 patients in this study. The median age was 12 months (1 day-18 years), and the median weight was 7 kg (2.5 -82 kg). 18% of the patients had single ventricle physiology. Total correction was performed in 88% of the patients. Median RACHS 1 score was 2 (1–6). PCILOS was>112 hours and total mortality was 4%. The 0th hour VVR ICU c index=0.73 (CI: 0.70–0.77), mortality c index=0.77 (CI: 0.69–0.85). VVR at 24th hour ICU c index=0.75 (CI: 0.71–0.79), mortality c index=0.86 (CI: 0.81–0.91). VVR at 48th-hour ICU c index=0.87 (CI: 0.82–0.92), mortality c index=0.92 (CI: 0.87–0.97). The VVR score at 48th-hour was a strong indicator for the prediction of both LICU duration (odds ratio [OR]: –1.44; p=0.001) and hospital mortality (OR: –1.28; p=0.001).
CONCLUSION: The postoperative VVR score can be a strong determinant for the prediction of early clinical results in congenital heart disease patients, which were considerably a heterogeneous group.

Vasoaktif-ventilasyon-böbrek Skorunun Pediyatrik Kalp Cerrahisi Operasyonu Sonuçlarýna Etkisi

Giriþ ve Amaç; Bu çalýþmada çocuklarda Vasoaktif-ventilasyon-böbrek(VVR) skorununun pediyatrik kalp cerrahisi sonuçlarýný deðerlendirmekteki etkisi araþtýrýldý.
Materyal ve Method: 1 Temmuz 2018- 31 Aralýk 2018 tarihleri arasýnda prospektif olarak, konjenital kalp cerrahisi operasyonu yapýlmýþ olan 18 yaþ altý olgular üzerinde gerçekleþtirildi. Ýlk 72 saat içinde ECMO desteði gereksinimi olan olgular çalýþma dýþý býrakýldý. Operasyon sonrasý yoðun bakýma alýnan olgularýn baþlangýç, 24.saat ve 48.saat Vazoaktif inotrop skoru(VÝS) ve VVR skorlarý hesaplandý. Toplam kalýþ süresinin % 25 persantilinden uzun kalma olarak deðerlendirilen; uzun yoðun bakým süreci (UYB) ve hastane mortalitesine(<30 günden önce) etkileri deðerlendirildi.
Bulgular: Çalýþmada 340 olgu mevcuttu. Olgularýn median yaþý 12 ay ( 1 gün-18 yaþ) ve median aðýrlýk 7 kg( 2.5 -82 kg) idi.Olgularýn %18’i tek ventrikül fizyolojisine sahipti ve %88 olguya total koreksiyon yapýlmýþtý. Median RACHS 1 2 (1-6) idi. UYB süresi > 112 saat ve total mortalite % 4 idi. VVR 0.saat UYB c indexi= 0.73( CI: 0.70-0.77), mortalite c indexi= 0.77( CI: 0.69-0.85) idi.VVR 24.saat UYB c indexi= 0.75( CI: 0.71-0.79), mortalite c indexi= 0.86( CI: 0.81-0.91) idi.VVR 48.saat UYB c indexi= 0.87( CI: 0.82-0.92), mortalite c indexi= 0.92( CI: 0.87-0.97) idi 48.saat VVR skoru hem UYB süresi (odds ratio [OR] – 1.44; P = 0.001) hem de hastane mortalitesini (OR – 1.28; P = 0.001) ön görmede güçlü bir belirteçti.
Tartýþma ve Sonuç: Oldukça heterojen yapýlý konjenital kalp olgularýnda operasyon sonrasý VVR skoru; erken bir zamanda klinik sonuçlarý öngörmede güçlü bir belirleyici olabilir. (NCI-2019-0259.R1)