title: Preoperative liver dysfunction influences blood product administration and alterations in circulating haemostatic markers following ventricular assist device implantation.
abstract: OBJECTIVE
  Preoperative liver dysfunction may influence haemostasis following ventricular assist device (VAD) implantation. The Model for End-stage Liver Disease (MELD) score was assessed as a predictor of bleeding and levels of haemostatic markers in patients with currently utilized VADs.
  
  
  METHODS
  Sixty-three patients (31 HeartMate II, 15 HeartWare, 17 Thoratec paracorporeal ventricular assist device) implanted 2001-11 were analysed for preoperative liver dysfunction (MELD) and blood product administration. Of these patients, 21 had additional blood drawn to measure haemostatic marker levels. Cohorts were defined based on high (≥18.0, n = 7) and low (<18.0, n = 14) preoperative MELD scores.
  
  
  RESULTS
  MELD score was positively correlated with postoperative administration of red blood cell (RBC), platelet, plasma and total blood product units (TBPU) , as well as chest tube drainage and cardiopulmonary bypass time. Age and MELD were preoperative predictors of TBPU by multivariate analysis. The high-MELD cohort had higher administration of TBPU, RBC and platelet units and chest tube drainage postimplant. Similarly, patients who experienced at least one bleeding adverse event were more likely to have had a high preoperative MELD. The high-MELD group exhibited different temporal trends in F1 + 2 levels and platelet counts to postoperative day (POD) 55. D-dimer levels in high-MELD patients became elevated versus those for low-MELD patients on POD 55.
  
  
  CONCLUSIONS
  Preoperative MELD score predicts postoperative bleeding in contemporary VADs. Preoperative liver dysfunction may also alter postoperative subclinical haemostasis through different temporal trends of thrombin generation and platelet counts, as well as protracted fibrinolysis.
authors.affiliation: Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Woolley
authors.affiliation: McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Cardiovascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.affiliation: The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
authors.affiliation: The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Cardiovascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.affiliation: The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Cardiovascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.affiliation: The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Lockard
authors.affiliation: The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Kunz
authors.affiliation: Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Cardiovascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA wagnerwr@upmc.edu.
authors.forename: William R
authors.initials: WR
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005342:Fibrinolysis; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count
chemical_list: D015415:Biomarkers
keywords: Assisted, Transplantation; Heart; Heart Failure, Ventricular Assist Device, Circulation