Artif Organs. 2023 Jul 21. doi: 10.1111/aor.14617. Online ahead of print.
ABSTRACT
BACKGROUND: Short-term continuous flow (STCF) ventricular assist devices (VADs) are utilized in adults with cardiogenic shock, however, mortality remains high. Previous studies have found that high pre-operative MELD-XI scores in durable VAD patients is associated with mortality. The use of the MELD-XI score to predict outcomes in STCF-VAD patients has not been explored. We sought to determine the relationship between MELD-XI and outcomes in adults with STCF-VADs.
METHODS: This was a retrospective review of adults implanted with STCF-VADs between 2009-19. Receiver operating characteristic (ROC) analysis was performed to predict outcomes and Kaplan-Meier analysis was done to assess survival.
RESULTS: Seventy-nine patients were included with a median MELD-XI score of 21.2 (IQR 13.5, 27.0). Patients with an unsuccessful wean from support (p<0.001) or major post-operative bleeding (p=0.03) had significantly higher pre-implant MELD-XI scores. The optimal MELD-XI cut-point for mortality was 24.9 with 27.8 for major bleeding. Survival was worse among patients in the high-risk MELD-XI group, however, not statistically significant (p=0.09). Prior ECMO support, but not MELD-XI, was an independent predictor of unsuccessful wean (p=0.03).
CONCLUSIONS: Pre-operative MELD-XI score was a moderate predictor of unsuccessful wean with limited utility in predicting bleeding in patients on STCF-VAD support. This scoring system may be useful in the clinical setting for pre-implant risk stratification and counselling among patients and outcomes.
PMID:37476924 | DOI:10.1111/aor.14617
