This retrospective study complied with the Helsinki Declaration (2000), and approval to perform this analysis was given by the local Ethics Committee (EC, No.22–261-Br), based on the model of the study. The aim of the study was to develop a risk model to predict mortality in surgical patients with respect to their MELD Score. In the present study, the authors have reviewed retrospectively the MELD Score of patients undergoing heart surgery from 2000 to 2019 and the mortality in these patients after all-type cardiothoracic operations with cardiopulmonary bypass. Due to the various synthetic functions of the liver, which are critical to the postoperative period, postoperative hepatic dysfunction results in increased postoperative morbidity and mortality. However, patients with liver disease, which has not progressed to its end stage, also have increased mortality and need further assessment. Studies that evaluate MELD Score for risk stratification in patients undergoing cardiac surgery focus on outcomes in patients with cirrhosis. Liver disease has been shown to increase postoperative mortality after heart surgery by up to 22% as an independent risk factor, and patients with cirrhosis have been shown to have higher rates of mortality. Although both scores are detailed and provide a reliable framework for risk assessment in patients undergoing heart surgery, their designs do not provide risk evaluation for patients with liver disease, depending on the severity of the disease. With the rising number of multimorbid patients undergoing cardiac surgery, preoperative risk stratification is becoming increasingly important.Ĭurrent risk stratification scores used for patients undergoing heart surgery include EUROSCORE II and STS Short-Term Risk Calculator. The MELD Score has since also been used to assess the risk of patients with liver cirrhosis undergoing heart surgery. Thus, the MELD Score established itself as a valid method to predict the survival of patients with end-stage liver disease. as a model to predict the outcomes of patients with portal hypertension undergoing Trans jugular intrahepatic portosystemic shunts (TIPS), and was adopted by UNOS to improve allocation times for patients waiting for a liver transplant. The MELD Score was first described by Kamath, Malinchoc, Gordon et al. As the current risk stratification scores do not consider this, we recommend applying the MELD score before considering patients for cardiac surgery. A higher mortality was observed in patients with reduced liver and renal function, with a significant increase in patients with a MELD score > 20. Incidentally, an increased MELD Score was not associated with a significant increase in the postoperative incidence of stroke/TIA or the presence of sternal wound infections/complications. The highest rates of postoperative bleeding (13.8%) and, repeat thoracotomy (13.2%) & postoperative pneumonia (17.4%) were seen in Group 3 (threefold increase when compared to Group 1, renal failure requiring dialysis ( N = 235, 2.7% in Group 1 v/s N = 78, 22.9% in Group 3) or requiring high dose catecholamines post-operatively or mechanical circulatory support (IABP/ECLS). To perform a univariate analysis of the data, patients were classified into three groups based on the MELD Score: MELD 20 experienced a 31.2% postoperative mortality, compared to Group 1 (4.6%) and Group 2 (17.5%). We retrospectively examined patient data using the MELD score as a predictor of mortality. Risk stratification, using scores such as EURO Score II or STS Short-Term Risk Calculator for patients undergoing cardiac surgery with cardiopulmonary bypass, ignores the quantitative renal and hepatic function therefore, MELD-Score was applied in these cases. The outcome of the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) is also influenced by the renal and hepatic organ functions.
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