Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery†

Tsuda, Kazumasa; Koide, Masaaki; Kunii, Yoshifumi; Watanabe, Kazumasa; Miyairi, Satoshi; Ohashi, Yuko; Harada, Takashi

doi:10.1093/icvts/ivt014

Cited by 24 publications

(16 citation statements)

References 18 publications

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“…Recently, MELD scores have been used extensively to predict operative mortality in patients undergoing cardiac surgery [17,18]. In fact, evidence shows that MELD is highly predictive of mortality in tricuspid surgical patients [19,20]. An MELD > 15 score was associated with a nine-fold higher odds of mortality in emergency cardiac transplantation [21].…”

Section: Discussionmentioning

confidence: 99%

Model for End-Stage Liver Disease Score Predicts the Mortality of Patients with Coronary Heart Disease Who Underwent Percutaneous Coronary Intervention

Chen

Han

Zheng

et al. 2021

Cardiology Research and Practice

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Background. Coronary heart disease (CHD) is caused by the blockage or spasm of coronary arteries. Evidence shows that liver disease is related to CHD. However, the correlation between the Model for End-Stage Liver Disease (MELD) score and outcomes in patients after percutaneous coronary intervention (PCI) was unclear. Method. A retrospective cohort study involved 5373 patients with coronary heart disease after PCI was conducted from January 2008 to December 2016. Participants were classified to four groups according to the MELD score by quartiles. The primary endpoint was long-term mortality including all-case mortality (ACM) and cardiac mortality (CM). Secondary endpoints included bleeding events, readmission, major adverse cardiovascular events (MACE), major adverse cardiovascular, and cerebrovascular events (MACCE). The longest follow-up time was almost 10 years. Results. There were significant differences in the incidences of ACM ( p = 0.038 ) and CM ( p = 0.027 ) among the four MELD groups, but there was no significant difference in MACEs ( p = 0.496 ), MACCEs ( p = 0.234 ), readmission ( p = 0.684 ), and bleeding events ( p = 0.232 ). After adjusting the age, gender, smoking, drinking status, and diabetes by a multivariable Cox regression analysis, MELD remains independently associated with ACM (HR:1.57, 95%CI 1.052–2.354, p = 0.027 ) and CM (HR:1.434, 95% CI 1.003–2.050, p = 0.048 ). Conclusion. This study indicated that the MELD score had a strong prediction for long-term mortality in CHD patients who underwent PCI.

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Section: Discussionmentioning

confidence: 99%

Model for End-Stage Liver Disease Score Predicts the Mortality of Patients with Coronary Heart Disease Who Underwent Percutaneous Coronary Intervention

Chen

Han

Zheng

et al. 2021

Cardiology Research and Practice

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“…der Child-Pugh-Klassifikation hat sich in der klinischen Praxis zur Beurteilung der Operabilität von Patenten mit einer Leberfunktionseinschränkung auch der Model End Stage Liver Disease Score (MELD-Score) etabliert. In einer Kohorte von Patienten, die aufgrund isolierter TI operiert wurden, konnte ein exponentieller Zusammenhang zwischen steigendem MELD-Score und steigender Krankenhausletalität nachgewiesen werden, mit der höchsten Sterblichkeitsrate von 66 % für Patienten mit einem MELD-Score > 14 [22]. Diese Patienten sind perioperativ durch ein hohes Risiko für das Auftreten von Blutungskomplikationen, vasoplegischem, hyperdynamem Kreislaufversagen, Infektionen und Rechtsherzversagen gefährdet.…”

Section: Präinterventionelle Risikostratifizierungunclassified

Chirurgische Optionen bei Trikuspidalklappeninsuffizienz

et al. 2019

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ZusammenfassungTrikuspidalklappeninsuffizienz (TI) ist eine häufige Begleitdiagnose bei Patienten mit einem dominierend linkskardialen Vitium oder auch einer myokardialen Dysfunktion. Daneben können Patienten mit einer Reihe von anderen Grunderkrankungen, wie etwa infektiöser Endokarditis oder auch schrittmacherpflichtiger Herzrhythmusstörung, von einer isolierten TI betroffen sein. Bei schwerer Ausprägung der TI stellt eine Operation in vielen Fällen den heute praktizierten therapeutischen Standard dar, wenn auch die aktuelle Datenlage sehr lückenhaft ist und die Empfehlungen der Fachgesellschaften einen niedrigen Evidenzlevel aufweisen. Diese Arbeit beschreibt die heute verfügbaren chirurgischen Optionen zur Therapie der primären und sekundären TI mit Berücksichtigung der komplexen diagnostischen und therapeutischen Konstellation im Falle der letztgenannten Form.

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“…It has been demonstrated to predict operative mortality after tricuspid surgery and cardiac surgery in general. [3][4][5][6][7] In this case series, we aim to quantify the impact of hepatorenal dysfunction using MELD and evaluate its ability to predict operative mortality after triple valve surgery (TVS).…”

Section: Introductionmentioning

confidence: 99%

Hepatorenal Dysfunction Predicts Operative Mortality After Triple Valve Surgery: Utility of MELD-Na

Lim¹,

Chow²,

Ho³

et al. 2021

Preprint

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Background Despite significant advancements in operative techniques and myocardial protection, triple valve surgery (TVS) remains a formidable operation with a relatively high in-hospital mortality. We evaluated the prognostic value of Model for End-stage Liver Disease score including sodium (MELD-Na) for mortality after TVS and its predictive value when incorporated in the EuroSCORE risk model. Methods We performed a retrospective cohort study of 61 consecutive patients who underwent TVS from November 2005 to June 2016. Demographics, clinical, biochemical, and operative data were collected and analysed. Results Median follow-up duration was 8.0 years. 70.5% of patients suffered from rheumatic heart disease. 86.9% underwent mechanical double valve replacement with tricuspid valve repair. There were six operative deaths (9.84%), with the most common cause of death being multiorgan failure (83.3%). 26.2% had a moderately elevated MELD-Na score of 9 to 15, and 4.9% had a severely elevated score of >15. Patients with a MELD-Na >9 had a higher unadjusted rate of operative mortality, prolonged ventilation, need for dialysis and acute liver failure after TVS. Hierarchical logistic regression was performed using logistic EuroSCORE as the base model. After risk adjustment, each point of MELD-Na score increase was associated with 1.405 times increase in odds of operative mortality. The regression analysis was repeated by incorporating individual components of the MELD-Na score, including bilirubin, sodium, and albumin. All three biochemical parameters were significantly associated with operative mortality Conclusion MELD-Na score as a quantifier of hepatorenal dysfunction is sensitive and specific for mortality after triple valve surgery.

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Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery†

Abstract: The simplified MELD score predicts mortality in patients undergoing tricuspid valve surgery. This model requires only total bilirubin and creatinine and is therefore applicable in patients undergoing warfarin therapy.

Cited by 24 publications

References 18 publications

Model for End-Stage Liver Disease Score Predicts the Mortality of Patients with Coronary Heart Disease Who Underwent Percutaneous Coronary Intervention

Model for End-Stage Liver Disease Score Predicts the Mortality of Patients with Coronary Heart Disease Who Underwent Percutaneous Coronary Intervention

Chirurgische Optionen bei Trikuspidalklappeninsuffizienz

Hepatorenal Dysfunction Predicts Operative Mortality After Triple Valve Surgery: Utility of MELD-Na

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