Thorac Cardiovasc Surg 2016; 64 - OP25
DOI: 10.1055/s-0036-1571493

MELD Score is the Most Important Variable Predicting Outcome in Patients Receiving Long-term Ventricular Assist Device after Extracorporeal Life Support

D. Saeed 1, M. Abdeen 1, A. Albert 1, B. Maxhera 1, U. Boeken 1, R. Westenfeld 2, A. Lichtenberg 1
  • 1Dusseldorf University Hospital, Clinic for Cardiovascular Surgery, Dusseldorf, Germany
  • 2Dusseldorf University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Dusseldorf, Germany

Objectives: The implantation of long term ventricular assist devices (VADs) in patients on short term extracorporeal life support (ECLS) is controversial due to the expected devastating outcome in these patients. The aim of this study was to identify survival predictors in this cohort of patients using all preoperative available data including patients characteristics, results of blood gas analysis, blood chemistry and catecholamine doses prior to the VAD implantation surgery.

Methods: Data of patients undergoing VAD support between January 2010 and September 2015 were retrospectively reviewed. Inclusion criteria were patients with prior ECLS support. Outcome of survivors following long term VAD support is compared with non- survivor patients. Students t or X2 test is used as applicable.

Results: A total of 107 long term VADs were implanted. The inclusion criteria were met by 39 patients. Nineteen patients (49%) expired at different points after VAD implantation. All preoperative characteristics were comparable between these 2 groups except for a statistically higher Model for End-stage Liver Disease (MELD) score (23 ± 9 versus 14 ± 7) and bilirubin values (6.4 ± 7.3 mg/dL versus 2.2 ± 2.3 mg/dL) in non- survivor cohort of patients (p = 0.001 and 0.02 respectively). Basically, none of the patients with MELD score >25 survived the first 6 month after VAD implantation (Fig. 1). Postoperative complications included right heart failure requiring right VAD in 27 patients (69%), respiratory failure (as per INTERMACS) in 28 patients (72%), renal failure (as per INTERMACS) in 23 patient (59%), hepatic failure (as per INTERMACS) in 18 patient (46%) and bleeding requiring resternotomy in 10 patients (26%).

Fig. 1.

Conclusions: In this, to our knowledge, the largest published study including VAD patients with prior ECLS support, pre VAD MELD score seems to be the most important factor predicting survival after VAD implantation. Survival in VAD patients with prior ECLS support remains limited and associated with significantly higher postoperative complications compared with VAD patients without prior ECLS support.