• Heart · Apr 2013

    MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery.

    • Gabriele Egidy Assenza, Dionne A Graham, Michael J Landzberg, Anne Marie Valente, Michael N Singh, Aamir Bashir, Susan Fernandes, Koenraad J Mortele, Chinweike Ukomadu, Massimo Volpe, and Fred Wu.
    • Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. gabriele.egidyassenza@cardio.chboston.org
    • Heart. 2013 Apr 1;99(7):491-6.

    ObjectiveThe Fontan operation is a staged palliation for complex congenital heart disease and single ventricle physiology. Perioperative survivors of the Fontan operation experience long-term cardiac complications, including death. Liver and renal dysfunction are reported in these patients and have a direct effect on morbidity and mortality. This study aims to investigate whether the Model for End-stage Liver Disease eXcluding INR score (function of creatinine and total bilirubin, MELD-XI) predicts risk for cardiac mortality or transplantation in patients with Fontan circulation.Design And SettingRetrospective, single-centre study. Time of first evaluation was the time of the earliest available MELD-XI score measurement, and follow-up was terminated by a cardiac event or by the last clinical evaluation.PatientsPatients surviving after Fontan surgery and evaluated at Boston Children's Hospital between 1993 and 2008.Main Outcome MeasureComposite endpoint of sudden death, death from congestive heart failure or cardiac transplantation.ResultsThe MELD-XI score was calculated as MELD-XI=11.76(loge creatinine)+5.112(loge total bilirubin)+9.44. Ninety-six patients were included (52 male, median age 26 years). After a mean follow-up period of 5.7 years, 18 patients (19%) experienced the composite end point. Baseline MELD-XI score was independently and directly related to the incidence of the composite endpoint (HR for high MELD-XI score group of 7.76, 95% CI 2.05 to 29.33, p=0.008).ConclusionsFontan patients with a higher MELD-XI score have shorter freedom from sudden cardiac death, death from congestive heart failure and cardiac transplantation.

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