Prognostic value of MELD-XI and MELD-Albumin scores in double valve replacement

Abstract Background: Patients who undergo concomitant aortic and mitral double valve replacement (DVR) have poor postoperative clinical outcomes. The modified Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) score and the modified Model for End-Stage Liver Disease score with albumin replacing international normalized ratio (MELD-albumin) score have been reported as predictors of adverse events in hepato-cardiac diseases. The objective of this study was to assess the clinical prognostic value of the two modified Model for End-Stage Liver Disease (MELD) scores in patients undergoing DVR. Methods: A total of 210 patients undergoing DVR were evaluated. Baseline clinical and laboratory parameters were recorded, and EuroSCORE II was calculated for each patient. The outcome of interest was the composite of heart failure hospitalization and cardiovascular mortality. Results: Patients undergoing DVR had a high prevalence of hepato-renal dysfunction. During a median follow-up of 71 months, the MELD-XI and MELD-Albumin scores independently predicted adverse outcomes (hazard ratio [95% confidence interval] = 1.09 [1.03–1.16] and 1.11 [1.06–1.16], P < 0.01, respectively). Kaplan–Meier analysis demonstrated that high MELD-XI and MELD-Albumin scores were associated with an increased risk of adverse events. MELD-Albumin provided incremental prognostic value to clinical parameters and EuroSCORE II (net reclassification index [NRI] = 0.34; P < 0.01). Conclusions: Both the MELD-XI score and MELD-Albumin score can provide useful information to predict adverse outcomes in patients undergoing DVR. The present study supports the monitoring of modified MELD scores to improve preoperative risk stratification for these patients.