CONGRESS ABSTRACT

Background and Goal of Study Right ventricular dysfunction (RVD) is a major postoperative complication after cardiac surgery and is associated with significant morbidity and mortality. Inotropic support is essential for maintaining hemodynamic stability, yet no consensus exists on the optimal agent or intensity of support. The Vasoactive Inotropic Score (VIS) provides an objective measure of circulatory support, but validation in cardiac surgery remains limited. This study evaluated the association between postoperative VIS and intensive care outcomes in patients with RVD and explored the impact of individual inotropic agents. Materials and Methods We conducted a retrospective single-centre cohort study including 153 cardiac surgery patients admitted to the Cardiothoracic ICU of Policlinico Universitario Campus Bio-Medico, Rome (January 2021–September 2023). Inclusion criteria were echocardiographically confirmed postoperative RVD and need for inotropic or vasopressor support. Clinical, echocardiographic and pharmacologic data were collected, and VIS 2020 was calculated. Outcomes included mortality, acute kidney injury (AKI), need for non-invasive ventilation (NIV), reintubation and ICU length of stay (LOS). Multivariable logistic and linear regression analyses were performed (p < 0.05). Results and Discussion Mean age was 70 ± 10 years, with 75% male. VIS was independently associated with NIV (OR 1.04; p = 0.008), reintubation (OR 1.04; p = 0.013), AKI (p = 0.020) and prolonged ICU LOS (β = 0.030; p < 0.001). Each 1-point increase in VIS corresponded to an estimated 3% increase in LOS. These associations remained significant after adjustment for EuroSCORE II and echocardiographic parameters. In inotrope-specific analyses, dobutamine was associated with reduced risk of NIV (OR 0.25; p = 0.006) and AKI (OR 0.26; p = 0.010). Conclusions VIS is a marker of clinical severity and is associated with adverse outcomes in postoperative RVD. Higher VIS values identify patients at increased risk of complications and prolonged ICU stay. Dobutamine use may be linked to favourable renal and respiratory outcomes. At equal EuroSCORE, each 1-point increase in VIS independently prolongs ICU stay by about 3%, indicating that postoperative inotropic burden adds to LOS beyond preoperative surgical risk.VIS may support risk stratification and therapeutic decision-making in postoperative cardiac surgery.