Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, Texas; Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, Texas; Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas; Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
Ann Thorac Surg. 2018 Aug;106(2):513-519. doi: 10.1016/j.athoracsur.2018.02.082. Epub 2018 Apr 4.
The use of continuous-flow left ventricular assist devices (CF-LVADs) to treat advanced heart failure is increasing. Although risk scores, such as Model for End-Stage Liver Disease and the HeartMate II Risk Score, require the use of the international normalized ratio, many patients are on anticoagulation before CF-LVAD implantation. This study evaluated the ability of the Model of End-Stage Liver Disease-eXcluding International Normalized Ratio (MELD-XI) scoring system to predict clinical outcomes in patients with advanced heart failure who undergo CF-LVAD implantation.
A single-center retrospective review was performed of 524 patients who were implanted with the HeartMate II LVAD (Thoratec Corporation, Pleasanton, CA) or the HeartWare HVAD (HeartWare International Inc, Framingham, MA) between 2004 and 2016. Patients were stratified into two cohorts: those with a MELD-XI score of less than 14 (n = 301) and 14 or higher (n = 223).
Patients with the higher-risk MELD-XI score of 14 or higher demonstrated lower survival rates at 1, 3, 6, 12, and 24 months (p < 0.001 for all) and increased risk of early right heart failure and infections compared with patients with MELD-XI score of less than 14. MELD-XI was not significantly inferior at predicting 90-day mortality compared with the HeartMate II Risk Score (p = 0.92). Patients with elevated MELD-XI scores at follow-up demonstrated higher rates of mortality.
These findings suggest that a MELD-XI score of 14 or higher was associated with a higher postoperative mortality rate than that seen in patients with a lower MELD-XI score. The MELD-XI scoring system can be used to predict outcomes in patients with advanced heart failure who undergo CF-LVAD implantation.
使用持续流动左心室辅助装置（CF-LVAD）治疗晚期心力衰竭的情况正在增加。尽管风险评分，如终末期肝病模型和 HeartMate II 风险评分，需要使用国际标准化比值，但许多患者在 CF-LVAD 植入前就已经接受抗凝治疗。本研究评估了终末期肝病模型排除国际标准化比值（MELD-XI）评分系统在接受 CF-LVAD 植入的晚期心力衰竭患者中的预测临床结局的能力。
对 2004 年至 2016 年间植入 HeartMate II LVAD（Thoratec 公司，加利福尼亚州普莱森顿）或 HeartWare HVAD（HeartWare 国际公司，马萨诸塞州弗雷明汉）的 524 例患者进行了单中心回顾性研究。患者分为两组：MELD-XI 评分<14（n=301）和 14 或更高（n=223）。
MELD-XI 评分较高的 14 或更高风险组在 1、3、6、12 和 24 个月时的生存率较低（所有 p<0.001），与 MELD-XI 评分较低的患者相比，早期右心衰竭和感染的风险增加。与 HeartMate II 风险评分相比，MELD-XI 预测 90 天死亡率的效果并不差（p=0.92）。随访时 MELD-XI 评分升高的患者死亡率较高。
这些发现表明，与 MELD-XI 评分较低的患者相比，MELD-XI 评分 14 或更高与术后死亡率较高相关。MELD-XI 评分系统可用于预测接受 CF-LVAD 植入的晚期心力衰竭患者的结局。
