MELD-XI Predicts Severe Right Ventricular Failure after HeartMate 3 Implantation in a Contemporary Cohort

Background Right ventricular failure (RVF) after left ventricular assist devices (LVAD) is associated with significant morbidity and mortality and identifying patients at risk for severe RVF is an important clinical goal. Current risk prediction models were not developed in contemporary LVAD populations and have limited clinical applicability. Objectives To evaluate whether the Model for End Stage Liver Disease – eXcluding INR (MELD-XI) can predict severe RVF after HeartMate 3 (HM3) implantation. Methods We retrospectively analyzed all adult patients who received HM3 LVAD as initial implantation at two academic medical centers. We assessed whether MELD-XI is an independent risk factor for severe RVF in multivariate analysis and compared the predictive accuracy of MELD-XI with previously published risk scores. We also investigated the relationship between MELD-XI and markers of right ventricular function and whether MELD-XI was associated with death or pump exchange at 1-year follow-up. Results Our study included a total of 246 patients, of which 74 (30%) experienced severe RVF. After adjusting for relevant covariables, MELD-XI was independently associated with severe RVF (OR 1.18, CI 1.09-1.29, p<0.001) and performed similarly to the EUROMACS and Michigan RVF risk scores. In addition, MELD-XI was not reflective of traditional echocardiographic or hemodynamic measures of right ventricular function. Finally, MELD-XI ≥ 14 predicted worse in-hospital mortality. Conclusions Among patients undergoing HM3 implantation, MELD-XI is independently associated with an increased risk of RVF and in-hospital mortality.