Abstract 10318: Liver Dysfunction and Dynamics in Liver Function Parameters Predict Survival of Patients with Advanced Heart Failure Requiring Ventricular Assist Device Placement
Background: Liver dysfunction increases post-surgical morbidity and mortality. The Model of End-stage Liver Disease (MELD) estimates liver function but can be inaccurate in patients receiving oral anticoagulation. We sought to evaluate the impact of liver dysfunction on outcomes following ventricular assist device (VAD) implantation and the dynamic changes in liver dysfunction that occur during VAD support.
Methods: We retrospectively analyzed 255 patients who received a long-term VAD between January 2000 and September 2010. Liver dysfunction was estimated by MELD and MELD-eXcluding INR (MELD-XI, as described by Heuman, et al), with patients grouped as score ≥17 or <17. Primary outcomes were on-VAD, post-transplant and overall survival.
Results: MELD and MELD-XI correlated highly among patients not receiving anticoagulation (R≥0.901, p<0.0001). Patients with MELD or MELD-XI <17 had improved on-VAD and overall survival (all p-values ≤0.022). During VAD support, cholestasis initially worsened but subsequently improved over time. Patients with pre-VAD liver dysfunction who survived to transplant had lower post-transplant survival (p=0.0193). However, if MELD-XI normalized during VAD support, post-transplant survival improved and was similar to that of patients with low pre-VAD MELD-XI scores, both at 90-days (Figure 1; 88.1% vs 91.9%, p=0.5217) and 10-years (67.2% vs 73.5%, p=0.1164).
Conclusions: MELD-XI is a viable alternative for assessing liver dysfunction in heart failure patients on oral anticoagulation. Liver dysfunction is associated with worse survival following VAD placement. However, if MELD-XI improves during VAD support, post-transplant survival is similar to those without prior liver dysfunction, suggesting an important prognostic role for MELD-XI. We also found evidence of a transient cholestatic state following LVAD implantation that deserves further examination.
- © 2011 by American Heart Association, Inc.