Preoperative MELD-XI is not Associated with Mortality after LVAD

Abstract

Background: Kidney and liver dysfunction are common in patients with advanced heart failure undergoing left ventricular assistant device (LVAD) implantation. We have previously shown that Model of End-Stage Liver Disease excluding INR (MELD-XI) scores can predict poor outcomes after heart transplantation. Whether MELD-XI predicts outcomes after LVAD implantation is not well understood. Methods: All patients who underwent LVAD implantation at a tertiary referral center (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were included and preoperative MELD-XI was calculated. Cox proportional hazard models and Kaplan Meier method were used to describe association with overall post-implant mortality. Penalized smoothed splines were used to visualize the association between continuous MELDXI and mortality. Results: A total of 94 patients were included. Mean age was 60 §13 years, 78% males, 64% Caucasian, 76% had the HeartMate II. Median MELD-XI was 12.4(9.9-15.9). At a median follow-up of 2.8 years, 31 patients died. There was no difference between patients with MELD-XI >12.4 and MELD-XI 12.4 in overall mortality (P=0.14), figure (panel A). There was no association between continuous MELD-XI and mortality (HR 1.04; 95% CI: 0.96-1.13, P=0.32), figure (panel B). Conclusion: Our findings showed that MELD-XI is not associated with mortality after LVAD implantation. These findings need to be validated in a larger group registry to identify best bridging strategy in patients with advanced heart failure and combined kidney-liver dysfunction.Introduction: As the number of persons living with advanced heart failure (HF) continues to increase, so does the implantation of mechanical circulatory support devices. Over half of the left ventricular assist devices (LVADs) currently implanted are indicated for destination therapy (DT) but there is a gap in the current evidence regarding the end-of-life experiences (EOL) of this group. Purpose: To investigate the EOL experiences of LVAD-DT recipients and their family caregivers throughout the LVAD-DT trajectory including: 1) pre-implantation experiences, 2) conversations about device deactivation, 3) use of EOL services including palliative care and hospice, and 4) device deactivation prior to death. Methods: Thirty five individuals and their family caregivers (n=70) from 2 longitudinal prospective studies participated in qualitative interviews that occurred approximately every month for up to 24 months or until the death of the LVAD-DT recipient. After the death of LVAD-DT recipient, the caregiver was interviewed about LVAD deactivation and use of EOL services. Qualitative content analysis was utilized to explore the experiences of participants through the EOL. EOL service utilization determined via EMR review. Results: During study enrollment LVAD-DT recipients had on average 6 readmissions. The main reasons for readmission included: infection/ sepsis, GI bleed, RHF, and anemia. Sixty percent of the dyads (21/35) received a palliative care consult prior to implantation...