Hepatorenal Dysfunction Predicts Operative Mortality After Triple Valve
Surgery: Utility of MELD-Na
Abstract
Background Despite significant advancements in operative techniques and
myocardial protection, triple valve surgery (TVS) remains a formidable
operation with a relatively high in-hospital mortality. We evaluated the
prognostic value of Model for End-stage Liver Disease score including
sodium (MELD-Na) for mortality after TVS and its predictive value when
incorporated in the EuroSCORE risk model. Methods We performed a
retrospective cohort study of 61 consecutive patients who underwent TVS
from November 2005 to June 2016. Demographics, clinical, biochemical,
and operative data were collected and analysed. Results Median follow-up
duration was 8.0 years. 70.5% of patients suffered from rheumatic heart
disease. 86.9% underwent mechanical double valve replacement with
tricuspid valve repair. There were six operative deaths (9.84%), with
the most common cause of death being multiorgan failure (83.3%). 26.2%
had a moderately elevated MELD-Na score of 9 to 15, and 4.9% had a
severely elevated score of >15. Patients with a MELD-Na
>9 had a higher unadjusted rate of operative mortality,
prolonged ventilation, need for dialysis and acute liver failure after
TVS. Hierarchical logistic regression was performed using logistic
EuroSCORE as the base model. After risk adjustment, each point of
MELD-Na score increase was associated with 1.405 times increase in odds
of operative mortality. The regression analysis was repeated by
incorporating individual components of the MELD-Na score, including
bilirubin, sodium, and albumin. All three biochemical parameters were
significantly associated with operative mortality Conclusion MELD-Na
score as a quantifier of hepatorenal dysfunction is sensitive and
specific for mortality after triple valve surgery.