Model for End Stage Liver Disease Excluding International Normalized Ratio Predicts Severe Right Ventricular Failure After HeartMate 3 Implantation in a Contemporary Cohort.

Abstract

Background: Right ventricular failure (RVF) after left ventricular assist devices is associated with significant morbidity and mortality. Therefore, identifying patients at risk for severe RVF is important for clinical decision-making. Current risk prediction models were not developed in contemporary populations with left ventricular assist devices and have limited clinical applicability. In this study, we sought to evaluate whether the Model for End Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) can predict severe RVF after HeartMate 3 implantation.

Methods: We retrospectively analyzed all adult patients who received HeartMate 3 left ventricular assist devices as initial implantation at 2 academic medical centers. We assessed whether MELD-XI is an independent risk factor for severe RVF in multivariate analysis and compared the predictive accuracy of MELD-XI with previously published risk scores. We also investigated the relationship between MELD-XI and markers of RV function and whether MELD-XI was associated with death or pump exchange at 1-year follow-up.

Results: Our study included a total of 246 patients, of whom 74 (30%) experienced severe RVF. After adjusting for relevant covariables, MELD-XI was independently associated with severe RVF (odds ratio [OR], 1.18 [95% CI, 1.09-1.29]; P<0.001) and performed similarly to the EUROMACS (European Registry for Patients with Mechanical Circulatory Support) and Michigan RVF risk scores. In addition, MELD-XI was not reflective of traditional echocardiographic or hemodynamic measures of right ventricular function. Finally, MELD-XI ≥14 predicted worse in-hospital mortality.

Conclusions: Among patients undergoing HeartMate 3implantation, MELD-XI is independently associated with an increased risk of RVF and in-hospital mortality.