Preoperative MELD-XI Score and Risk of Heart Failure After Mitral Valve Surgery for Degenerative Mitral Regurgitation

This study aimed to assess the association between the Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) score and heart failure (HF) after isolated mitral valve surgery for degenerative mitral valve regurgitation (dMR).

Patients undergoing mitral valve surgery for dMR were divided into groups of high MELD-XI score (>11, n = 28) and low MELD-XI score (≤11, n = 144). The primary end point was early HF events, defined as operative mortality, use of mechanical circulatory support, and prolonged use of inotropic agents after the surgery. The secondary end point was a composite outcome consisting of all-cause mortality and HF admission. The median follow-up period was 338 (70-789) days.

Thirty-day mortality rate was 0.7% in the low MELD-XI score group and 3.6% in the high MELD-XI score group (P = .737). The prolonged use of inotropic agents was significantly higher in the high MELD-XI score group than in the low MELD-XI score group (25.0% vs 6.9%; P = .015). Freedom from composite outcomes was significantly lower in the high MELD-XI score group than in the low MELD-XI score group (log-rank, P < .001). MELD-XI score (odds ratio, 1.10 [95% CI, 1.01-1.19]; P = .023) was identified as a significant risk factor of the early HF events. Multivariate Cox regression analysis found the MELD-XI score (hazard ratio, 1.07 [95% CI, 1.01-1.14]; P = .027) to be a significant risk factor for the composite outcome after surgery.

In patients undergoing isolated mitral valve surgery for dMR, elevated preoperative MELD-XI score was associated with an increased risk of early HF events and the composite outcome.