MELD Score: A Predictor of Mortality for Patients Receiving RVAD after LVAD Implantation

Abstract

Purpose Right ventricular failure (RVF) after LVAD implantation leads to poor prognosis. Use of Right ventricular assist device (RVAD) has become a standard practice for RVF. Even with RV support mortality up to 40% is observed. Aim of this study is to identify predictors of mortality in patients supported with an RVAD. Methods Retrospective analysis of 16 patients who received an RVAD after an LVAD implantation were carried out. Primary end point was death. Patient's demographic, pre-op labs, echo findings, indications and INTERMACS profile were assessed for mortality association. For normally distributed variables student's t-test was used, and non-parametric variables had Wilcoxon-Mann-Whitney test applied. Results 10 (62.5%) were male and 10 (62.5%) were African Americans. 6 (40%) died within 30 days of RVAD support. At time of hospital admission, variables among the “Survivor” vs. “Non-Survivor” were similar including the MELD score (30.4 ± 6.52 vs. 22.44 ± 9.37, p-value 0.0859). During admission patients were optimized for heart failure with inotropes and IABP. Prior to going for surgical implant majority showed an improvement of MELD score when compared to admission MELD. LVAD implantation was performed utilizing standard techniques. All RVAD implants (Protek-Duo, Tandem Life, Pittsburgh.PA) performed within first 48 hrs of LVAD implant. Poor survival was observed in patients who did not show an improvement in MELD score since admission “Non-Survivor” [Median 30(22-32)], vs. “Survivor” [Median 11(10-13)], p-value 0.0029. Mortality was 100% in patients; with MELD >30, 66.67% with MELD 20-29, 50% with MELD 15-19 and 0% in-group with MELD ≤14. Conclusion Increased mortality is observed among patients who failed to show any significant improvement in MELD score with interventions prior to LVAD implantation. Our data suggests higher MELD score can predict mortality in patients supported with an RVAD after LVAD implantation. Large multi-institutional studies are needed to support these initial findings.