Prognostic impact of hepatorenal function in patients undergoing transcatheter tricuspid valve repair

Abstract

Hepatorenal dysfunction is a strong risk factor in patients with heart failure (HF). We investigated the prognostic significance of hepatorenal dysfunction in 172 consecutive patients undergoing transcatheter tricuspid valve repair (TTVR). The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln(serum total bilirubin [mg/dl]) + 11.76 × ln(serum creatinine [mg/dl]) + 9.44. Patients were stratified into two groups: high (≥ 14) or low (< 14) MELD-XI score, according to the best cut-off value to predict a one-year composite outcome consisting of all-cause mortality and HF hospitalization. Compared to patients with low MELD-XI score (n = 121), patients with high MELD-XI score (n = 51) had a higher incidence of the composite outcome (47.1% vs. 17.4%; p < 0.0001). In the multivariable analysis, the MELD-XI score was an independent predictor of the composite outcome (adjusted hazard ratio: 1.12; 95% confidence interval [CI] 1.05–1.19; p = 0.0003). In addition, post-procedural TR < 3 + after TTVR was independently associated with a reduction in MELD-XI score six months after TTVR (adjusted odds ratio: 3.37; 95% CI 1.09–10.40; p = 0.03). Thus, the MELD-XI score was associated with the risk of one-year composite outcome, consisting of mortality and HF hospitalization, after TTVR and may help the risk stratification in patients undergoing TTVR.

Prognostic Value of Modified Model for End-Stage Liver Disease Score in Patients Undergoing Isolated Tricuspid Valve Replacement

“…Armed with this knowledge, we recommended that MELD-albumin should be considered in the preoperative evaluation scoring system prior to ITVR for risk stratification and patient selection. Furthermore, the prognostic value of the modified MELD score for transcatheter tricuspid repair has been confirmed by a previous study (10). For patients with high MELD-albumin scores, modified MELD scores could be a useful tool to select patients who might be better suitable for transcatheter tricuspid repair.…”

“…Recently, modified MELD scores, excluding INR (MELD-XI) or substituting INR with albumin (MELD-albumin), were developed to optimize the traditional MELD scores. Moreover, the prognostic value of modified MELD scores has been demonstrated for transcatheter or surgical tricuspid repair (9,10). However, the prognostic value of both MELD and modified MELD scores in patients who underwent ITVR was unknown.…”

Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

“…A total of 17 studies 12 , 13 , 18 , 22 – 26 , 28 – 36 were included in the analysis of procedural outcomes ( Table 2 and Supplementary Table 6 ). The pooled technical and procedural success rates were 93.9% (95% confidence interval (CI): 90.7%–96.4%) and 82.1% (95% CI: 74.0%–89.0%), respectively.…”

“…A total of nine studies 19 – 22 , 27 , 28 , 30 , 34 , 36 were included for analyzing long-term outcomes ( Supplementary Table 8 ). The median follow-up for the nine studies was 365 days.…”

Crossing the Boundaries of Treatment of Valvular Heart Disease in Patients With Liver Cirrhosis

“…With regards to transcatheter tricuspid valve interventions (TTVI) there is still less knowledge in LC population with only a few publications reporting improvement on liver function after TTVI (20,21)…”