Predicting outcomes following short‐term ventricular assist device implant with the MELD‐XI score

Abstract

AbstractBackgroundShort‐term continuous flow (STCF) ventricular assist devices (VADs) are utilized in adults with cardiogenic shock; however, mortality remains high. Previous studies have found that high pre‐operative MELD‐XI scores in durable VAD patients are associated with mortality. The use of the MELD‐XI score to predict outcomes in STCF‐VAD patients has not been explored. We sought to determine the relationship between MELD‐XI and outcomes in adults with STCF‐VADs.MethodsThis was a retrospective review of adults implanted with STCF‐VADs between 2009 and 2019. Receiver operating characteristic (ROC) analysis was performed to predict outcomes and Kaplan–Meier analysis was done to assess survival.ResultsSeventy‐nine patients were included with a median MELD‐XI score of 21.2 (IQR 13.5, 27.0). Patients with an unsuccessful wean from support (p < 0.001) or major post‐operative bleeding (p = 0.03) had significantly higher pre‐implant MELD‐XI scores. The optimal MELD‐XI cut‐point for mortality was 24.9 with 27.8 for major bleeding. Survival was worse among patients in the high‐risk MELD‐XI group, however, not statistically significant (p = 0.09). Prior ECMO support, but not MELD‐XI, was an independent predictor of unsuccessful wean (p = 0.03).ConclusionsPre‐operative MELD‐XI score was a moderate predictor of unsuccessful wean with limited utility in predicting bleeding in patients on STCF‐VAD support. This scoring system may be useful in the clinical setting for pre‐implant risk stratification and counseling among patients and outcomes.