Although designed for patients with primary liver disease, the MELD score has also been shown to predict mortality for patients with liver dysfunction undergoing non-transplant surgery. Since February 2002, the United Network for Organ Sharing (UNOS) has used a MELD score for liver transplantation organ allocation based on its utility. Subsequently, it has been validated as a predictor of survival in patients with end-stage liver disease. The MELD score was initially developed for patients undergoing transjugular intrahepatic portosystemic shunt placement. Tricuspid valve regurgitation grade (1,2,3,4) All statistical analysis was performed using SPSS statistics 19 (SPSS, Inc., Chicago, IL, USA). Variables entered into the model included those risk factors that had a significant ( P < 0.05) or near significant ( P < 0.20) influence on mortality by univariate analysis. Multivariate logistic regression analysis was performed to identify independent risk factors for hospital mortality after tricuspid valve surgery. Univariate analysis was performed by Fisher's exact tests for categorical variables and by Wilcoxon's rank-sum test for continuous variables. Preoperative variables, intraoperative variables and complications, including mortality, were evaluated.ĭata are represented as mean ± standard deviation. To examine the significance of the preoperative simplified MELD score in the postoperative course, patients were stratified according to simplified MELD 48 h. Univariate and multivariate analysis were performed to identify the risk factors related to mortality. A total of 129 patients (75%) were on warfarin preoperatively, most commonly for atrial fibrillation or history of prosthetic valve replacement. Simplified MELD score could be calculated in 168 patients (97.7%). Preoperative laboratory data, clinical findings and medical history were used to determine Child-Turcotte-Pugh classification and the simplified MELD score. Different types of prosthetic valves and methods of valvuloplasty were not distinguished.ĭemographics, preoperative comorbidities and operative variables were compared between patients who survived to hospital discharge and patients who died prior to discharge. The surgical procedure included tricuspid valve replacement (TVR) or tricuspid valvuloplasty (TVP). A total of 172 patients (male: 66, female: 106 mean age, 63.8 ± 10.3 years) underwent tricuspid valve surgery. This study was approved by the institutional ethics committee in our hospital. Thus, we devised a new scoring model: simplified MELD score, which was calculated as follows:Ī retrospective review was performed for all patients who underwent tricuspid valve surgeries at our institution from January 1991 to July 2011. Therefore, we excluded a variable of INR from the MELD score it had the same meaning as assessing INR to 1.0 (because if INR = 1.0, LN = 0). The MELD score is not applicable for these patients, as warfarin affects the INR. However, many patients who have tricuspid disease are receiving warfarin therapy, often for atrial fibrillation or a history of prosthetic valve replacement. It is calculated as follows: MELD = 3.8*LN + 9.6*LN + 11.2*LN + 6.4, where LN = log normal. The MELD score was originally devised to estimate the prognosis of patients with end-stage liver disease, and it takes into account three factors: serum total bilirubin, the international normalized ratio (INR) and creatinine levels. Recent reports suggest that the model for end-stage liver disease (MELD) score can predict mortality for patients undergoing cardiac surgery, especially for those undergoing tricuspid valve surgery. However, these systems have insufficient accuracy and usability. The risk of tricuspid surgery for patients with liver disease has been estimated via the Child-Turcotte-Pugh classification and asialoscintigraphy. For example, the Society of Thoracic Surgeons (STS) risk prediction model and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) do not take into account the presence of liver dysfunction. Īlthough liver disease is cited as a risk factor for mortality and complications after cardiac surgery, existing risk-scoring systems for cardiac surgery do not account for liver dysfunction. Therefore, despite the ease of surgical procedure, tricuspid valve surgery is associated with worse prognosis when compared with aortic valve and mitral valve surgery. Advanced tricuspid regurgitation is associated with pulmonary hypertension and congestive liver dysfunction. Patients undergoing tricuspid valve surgery have an operative mortality of 7–11%.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |