There is wide practice variation when deciding timing of ventricular assist device implantation for children with end-stage heart failure. The Model for End-stage Liver Disease score eXcluding INR (MELD-XI) is an easily calculated score that identifies derangements in liver and renal function, which is often present in advanced heart failure. This study, published in the Journal of Heart and Lung Transplantation, identified that this objective score can help stratify children at increased risk for morbidity and mortality after VAD implantation: “Significance of pre and post-implant MELD-XI score on survival in children undergoing VAD implantation.”
Researchers found the MELD-XI score to be useful for pre-implant risk stratification for all children irrespective of their age at implant, underlying diagnosis (cardiomyopathy or congenital heart disease) or the type of VAD utilized (implantable continuous or paracorporeal pulsatile) suggestive of its wide applicability in children. In fact, this score outperformed the traditional metrics that are utilized to assess renal (creatinine) and liver (bilirubin) function currently, in a multi-variable model.
Finally, there are currently no risk assessment tools that can identify children at increased risk for morbidity and mortality once a VAD has been implanted. Researchers found that continued risk assessment by calculating the MELD-XI score at 1 week after VAD implant can identify children who have not achieved optimal reversal of end-organ dysfunction. They suggested that in this cohort other medical (pulmonary vasodilators) or surgical (early RVAD implantation) may be considered early to improve outcomes.
Many ACTION researchers contributed to this important study:
- Shahnawaz Amdani and Gerard Boyle of Cleveland Clinic Children’s
- Jennifer Conway of Stollery Children’s Hospital
- Justin Godown of Monroe Carell Jr. Children’s Hospital at Vanderbilt
- Ashwin Lal of Primary Children’s Hospital
- Yuk Law of Seattle Children’s Hospital
- Angela Lorts of Cincinnati Children’s Hospital Medical Center
- David Rosenthal of Lucile Packard Children’s Hospital.
Amdani S, Boyle GJ, Cantor RS, Conway J, Godown J, Kirklin JK, Koehl D, Lal AK, Law Y, Lorts A, Rosenthal DN. Significance of pre and post-implant MELD-XI score on survival in children undergoing VAD implantation. J Heart Lung Transplant. 2021 Aug 30:S1053-2498(21)02485-2. doi: 10.1016/j.healun.2021.08.013. Epub ahead of print. PMID: 34598872.