Congenital & Pediatric Heart Disease Scores

Vasoactive-Ventilation-Renal (VVR) Score Calculator – Pediatric Cardiac Surgery Outcomes

Clinical calculation support · Verify results before clinical use

Postoperative VVR Assessment

Enter contemporaneous vasoactive doses, ventilator settings, arterial PaCO₂, and creatinine values.

—VVR score

Measurement time point

Select the postoperative time represented by the entered measurements. This selection does not change the equation.

Postoperative assessment

1. Vasoactive-inotropic support (VIS)

Enter the dose being administered at the selected measurement time. Use the specified units; enter zero when the drug is not being administered.

Dopamineµg/kg/min

Dobutamineµg/kg/min

Epinephrineµg/kg/min

Milrinoneµg/kg/min

VasopressinU/kg/min

Norepinephrineµg/kg/min

2. Ventilation index (VI)

VI = respiratory rate × (PIP − PEEP) × PaCO₂ / 1,000. Use values recorded at the same time point.

Patient is receiving invasive mechanical ventilation

Ventilator respiratory ratebreaths/min

Peak inspiratory pressure (PIP)cmH₂O

Positive end-expiratory pressure (PEEP)cmH₂O

Arterial PaCO₂mmHg

3. Renal score (ΔCr × 10)

Both creatinine values must use the same unit. The calculator accepts mg/dL or µmol/L and converts µmol/L to mg/dL before applying the published equation.

Creatinine unit

Preoperative baseline serum creatinine

Serum creatinine at selected time point

—VVR score

Awaiting calculation

Enter patient measurements

The composite score will be displayed after valid inputs are submitted. No universal risk category is assigned.

VVR is a continuous composite score. Interpret it in the context of the patient's clinical course and the population in which the score was studied.

About the VVR Score

The vasoactive-ventilation-renal (VVR) score combines markers of cardiovascular support, respiratory support, and renal dysfunction after pediatric cardiac surgery. It was developed to provide a broader assessment than vasoactive-inotropic support alone.

Calculation

VVR = VIS + VI + (ΔCr × 10)

Component	Published equation
VIS	Dopamine + dobutamine + (100 × epinephrine) + (10 × milrinone) + (10,000 × vasopressin) + (100 × norepinephrine)
VI	RR × (PIP − PEEP) × PaCO₂ / 1,000
Renal component	10 × max[0, postoperative creatinine − preoperative creatinine], in mg/dL

How to interpret the result

A higher VVR score reflects a greater combined burden of vasoactive support, ventilatory support, and creatinine increase.
The original and subsequent studies evaluated associations with outcomes such as prolonged mechanical ventilation, prolonged PICU stay, and mortality.
There is no single universally accepted VVR threshold or calibrated mortality probability applicable across all pediatric cardiac surgery populations.
Published cutoffs are cohort- and outcome-specific and should not be transferred automatically to another center or endpoint.

Measurement considerations

Use drug doses, ventilator settings, and arterial PaCO₂ measured at the same postoperative time point.
When the patient is extubated/not receiving ventilator support, VI is zero in the published method.
When postoperative creatinine is below baseline, the renal change is set to zero rather than a negative value.
Do not apply the score to patients on ECMO without a separately validated adaptation; ECMO populations use modified approaches.

Evidence and References

Miletic KG, Spiering TJ, Delius RE, Walters HL III, Mastropietro CW. (2015) Use of a novel vasoactive-ventilation-renal score to predict outcomes after paediatric cardiac surgery. Interactive CardioVascular and Thoracic Surgery. 20(3):289–295. DOI: 10.1093/icvts/ivu409.

Miletic KG, Delius RE, Walters HL III, Mastropietro CW. (2016) Prospective Validation of a Novel Vasoactive-Ventilation-Renal Score as a Predictor of Outcomes After Pediatric Cardiac Surgery. The Annals of Thoracic Surgery. 101(4):1558–1563. DOI: 10.1016/j.athoracsur.2015.11.006.

Alam S, Akunuri S, Jain A, et al. (2018) Vasoactive-ventilation-renal score in predicting outcome postcardiac surgery in children. International Journal of Critical Illness and Injury Science. 8(3):143–148. DOI: 10.4103/IJCIIS.IJCIIS_1_18.

Zubarioglu AU, Yıldırım Ö, Zeybek C, et al. (2021) Validation of the Vasoactive-Ventilation-Renal Score for Neonatal Heart Surgery. Cureus. 13(5):e15110. DOI: 10.7759/cureus.15110.

Abhay P, Sharma R, Bhan A, et al. (2023) Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery. Frontiers in Pediatrics. 11:1086626. DOI: 10.3389/fped.2023.1086626.

Clinical disclaimer: This calculator implements the published VVR equation and is intended for clinical assessment and educational use. It does not provide an individualized probability of death, determine disposition, or replace pediatric cardiac intensive care assessment. Prognostic performance and thresholds vary by age, surgical complexity, case mix, timing, and outcome definition. Clinical decisions should incorporate the full clinical picture and local protocols.