Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
ASAIO J. 2013 Jan-Feb;59(1):57-62. doi: 10.1097/MAT.0b013e31827c0c77.
Axial flow left ventricular assist device (LVAD) implantation is an effective therapy for patients with advanced heart failure. As the preoperative hepatic and renal function play a critical role in determining adverse events after LVAD implantation, we analyzed the predictive role of the model for end-stage liver disease (MELD) score in determining in-hospital mortality after surgery. One hundred twenty-six patients underwent implant of an LVAD at our institution. Their individual preoperative MELD scores and perioperative total blood product usage (TBPU) were calculated. As LVAD implant as a reoperation is known to influence postoperative bleeding and mortality independently, the patients were divided into group I (first cardiac surgery) and group II (reoperative surgery). Group I: LVAD implantation was performed in 68/126 (54%) patients as their first cardiac surgery. The mean MELD score was 16.3 ± 6. Median TBPU for this group was 20.7 (0, 135) units. Inhospital mortality/30-day mortality was 4/68 (5.8%). Increasing MELD score (c-statistic = 0.88) and TBPU were found to be predictors of early mortality. An increasing MELD score was associated with more TBPU (p < 0.01) with a 10.9 ± 3 TBPU increase per a 10 unit rise in the MELD score. Group II: Of the 126 patients, 58 (46%) underwent LVAD implantation as a reoperation. Mean MELD score for these patients was 16 ± 5. Inhospital mortality/30-day mortality in this group was 12% and median TBPU was 30 (4,153) units. The MELD score was not predictive of inhospital mortality in these patients (p = 0.97). The MELD score is predictive of early mortality in patients undergoing LVAD implantation as their first cardiac surgery. Use of this score to select patients for LVAD implantation may be appropriate.
轴流左心室辅助装置（LVAD）植入术是治疗晚期心力衰竭患者的有效方法。由于术前肝肾功能对 LVAD 植入术后不良事件的发生起着至关重要的作用，因此我们分析了终末期肝病模型（MELD）评分在预测术后住院死亡率方面的作用。本机构对 126 例患者进行了 LVAD 植入术。计算了每位患者的术前 MELD 评分和围手术期总血制品用量（TBPU）。由于已知 LVAD 植入术作为再次手术会独立影响术后出血和死亡率，因此将患者分为两组：I 组（首次心脏手术）和 II 组（再次手术）。I 组：68/126（54%）例患者首次接受心脏手术时行 LVAD 植入术。MELD 评分平均为 16.3±6. 该组的中位 TBPU 为 20.7（0，135）单位。住院死亡率/30 天死亡率为 4/68（5.8%）。MELD 评分增加（C 统计量=0.88）和 TBPU 被发现是早期死亡率的预测因素。MELD 评分增加与 TBPU 增加相关（p<0.01），MELD 评分每增加 10 单位，TBPU 增加 10.9±3 单位。II 组：126 例患者中有 58 例（46%）因再次手术而行 LVAD 植入术。这些患者的 MELD 评分为 16±5。该组的住院死亡率/30 天死亡率为 12%，中位 TBPU 为 30（4，153）单位。该评分对这些患者的住院死亡率无预测作用（p=0.97）。MELD 评分可预测首次接受心脏手术的 LVAD 植入患者的早期死亡率。使用该评分选择 LVAD 植入术患者可能是合适的。
