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MELD and MELD XI Scores as Predictors of Mortality After Pericardiectomy for Constrictive Pericarditis

Juan C Diaz Soto1, William J Mauermann1, Brian D Lahr2

  • 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

Mayo Clinic Proceedings
|March 6, 2021
PubMed
Abstract

Insights

The Model for End-Stage Liver Disease-XI (MELD-XI) and MELD scores effectively predict mortality and morbidity after pericardiectomy for constrictive pericarditis. These scores offer a reliable method for stratifying patient risk before surgery.

Area of Science:

  • Cardiovascular Surgery
  • Hepatology
  • Nephrology

Background:

  • Constrictive pericarditis necessitates surgical intervention via pericardiectomy.
  • Risk stratification is crucial for optimizing outcomes in patients undergoing major cardiac surgery.
  • The Model for End-Stage Liver Disease (MELD) and its variant MELD-XI are established predictors of mortality in various patient populations.

Purpose of the Study:

  • To evaluate the association between preoperative MELD and MELD-XI scores and postoperative outcomes in patients undergoing pericardiectomy.
  • To determine the predictive value of MELD and MELD-XI for mortality and morbidity following pericardiectomy for constrictive pericarditis.

Main Methods:

  • Retrospective analysis of 175-226 patients undergoing pericardiectomy for constrictive pericarditis (2007-2017).
  • MELD and MELD-XI scores were calculated within 30 days preoperatively.
  • Cox regression models assessed the association between scores and outcomes, adjusting for covariates. Primary outcome: 90-day mortality.

Main Results:

  • Higher MELD and MELD-XI scores were significantly associated with increased 90-day mortality (P<.001).
  • Both scores correlated with increased postoperative renal failure, need for transfusions, and chest tube output.
  • MELD-XI additionally predicted prolonged intubation and extended ICU/hospital stays.

Conclusions:

  • Preoperative MELD and MELD-XI scores are valuable tools for risk stratification in patients undergoing pericardiectomy.
  • MELD-XI demonstrated comparable or superior performance to MELD in predicting various adverse postoperative outcomes.
  • These scoring systems can aid in identifying high-risk patients for constrictive pericarditis surgery.

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