External Validation of the VExUS Score for the Prediction of Acute Renal Failure in Cardiac Surgery

External Validation of the VExUS Score for the Prediction of Acute Renal Failure in Cardiac Surgery

Acute renal failure is a frequent complication associated with significant morbidity and mortality in postoperative cardiac surgery.

The VExUS (Venous Excess UltraSound grading system) score was created to qualitatively assess this venous congestion, based on ultrasound data from patients obtained post operatively in cardiac surgery. These data included: inferior vena cava diameter, Doppler flow of the suprahepatic veins, portal trunk and renal veins.

This score is predictive of the onset of acute renal failure in the first 3 days after surgery.

The VExUS score has not been validated in an external and prospective way in cardiac surgery.

Acute renal failure is a frequent complication associated with significant morbidity and mortality in postoperative cardiac surgery.

The pathophysiology in this context is complex, poorly understood and the causes are multiple: underlying nephropathy, intra- or postoperative haemodynamic instability, the use of an extracorporeal circulation, inflammation, etc.

One of the other possible etiologies is venous congestion. This may be due to volume overload and/or isolated global or right heart dysfunction.

Early treatment could prevent the onset of ARF or reduce its consequences, hence the importance of being able to predict its onset.

The VExUS (Venous Excess UltraSound grading system) score was created to qualitatively assess this venous congestion, based on ultrasound data from patients obtained post operatively in cardiac surgery. These data included: inferior vena cava diameter, Doppler flow of the suprahepatic veins, portal trunk and renal veins.

This score is predictive of the onset of acute renal failure in the first 3 days after surgery.

The VExUS score has not been validated in an external and prospective way in cardiac surgery.

Inclusion Criteria:

• Scheduled cardiac surgery
• Affiliated to a social security system

Exclusion Criteria:

• Emergency surgery
• Chronic renal failure defined by a glomerular filtration rate of less than 30ml/min or dialysis.
• renal transplant recipients
• Cirrhosis and portal hypertension
• Setting up a left ventricular assist device implantation
• Patient under ECMO (ExtraCorporeal Membrane Oxygenation), intra-aortic balloon pump, or a mechanical circulatory support device such as IMPELLA
• No available operator to perform ultrasound scans
• Patients objecting to the use of their data in research
• Subject under guardianship or subject deprived of freedom
• Pregnant or breastfeeding women
• Resume surgery within 48 hours of scheduled surgery
• Lack of a trained operator to perform D+1 and D+2 ultrasound