title: Model for end-stage liver disease predicts right ventricular failure in patients with left ventricular assist devices.
abstract: High rates of right ventricular failure continue to affect postoperative outcomes in patients implanted with left ventricular assist devices (LVADs). Development of right ventricular failure and implantation with right ventricular assist devices is known to be associated with significantly increased mortality. The model for end-stage liver disease (MELD) score is an effective means of evaluating liver dysfunction. We investigated the prognostic utility of postoperative MELD on post-LVAD implantation outcomes. MELD scores, demographic data, and outcomes including length of stay, survival, and postoperative right ventricular failure were collected for 256 patients implanted with continuous flow LVADs. Regression and Kaplan-Meier analyses were used to investigate the relationship between MELD and all outcomes. Increased MELD score was found to be an independent predictor of both right heart failure and necessity for RVAD implantation (OR 1.097, CI 1.040-1.158, p = 0.001; OR 1.121, CI 1.015, p = 0.024, respectively). Patients with RV failure and who underwent RVAD implantation had reduced postoperative survival compared to patients with RV dysfunction (no RV failure = 651.4 ± 609.8 days, RV failure = 392.6 ± 444.8 days, RVAD = 89.3 ± 72.8 days; p < 0.001). In conclusion, MELD can be used to reliably predict postoperative right heart failure and the necessity for RVAD implantation. Those patients with RV failure and RVADs experience significantly increased postoperative mortality compared to those without RV dysfunction.
authors.affiliation: Center for Heart Transplant and Assist Devices, Outpatient Pavilion, H&V Administration, Advocate Christ Medical Center, 6th Floor, 4440 West 95th Street, Oak Lawn, IL, 60453, USA. Gyost2@uic.edu.
authors.forename: Gardner L
authors.initials: GL
authors.lastname: Yost
authors.affiliation: Center for Heart Transplant and Assist Devices, Outpatient Pavilion, H&V Administration, Advocate Christ Medical Center, 6th Floor, 4440 West 95th Street, Oak Lawn, IL, 60453, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Coyle
authors.affiliation: Center for Heart Transplant and Assist Devices, Outpatient Pavilion, H&V Administration, Advocate Christ Medical Center, 6th Floor, 4440 West 95th Street, Oak Lawn, IL, 60453, USA. Geetha.Bhat@advocatehealth.com.
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
authors.affiliation: Division of Cardiothoracic Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Antone J
authors.initials: AJ
authors.lastname: Tatooles
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000175:diagnosis*; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000601:surgery
keywords: Circulatory assist devices, LVAD, RVAD; Liver; Outcomes; Statistics, risk analysis; Ventricle, right