Introduction

In Hong Kong, patients indicated for concomitant poly-valvular surgery were often referred for surgical assessment late in the course of their disease. Severe pulmonary hypertension, impaired biventricular function, and hepatorenal dysfunction were highly prevalent in these patients. Despite significant advancements in operative techniques and myocardial protection, concomitant operations on the trifecta of aortic, mitral and tricuspid valves still mandates a prolonged period of cardiopulmonary bypass and myocardial ischemia, which may overwhelm the limited cardiopulmonary and visceral reserve in these patients.
Risk stratification is one of the cornerstones of modern cardiac surgery.1 Although a myriad of scoring systems are available for coronary and valvular procedures, both the modern iterations of EuroSCORE and STS risk calculator were designed with coronary or single-valve operations in mind.2 Neither scoring system took liver function into account.
The Model for End-stage Liver Disease (MELD) is a scoring system originally developed to predict short-term mortality in patients with cirrhosis and trans-jugular intrahepatic portosystemic shunt, first adopted by the United Network for Organ Sharing for prioritizing liver recipients in 2002. It has been demonstrated to predict operative mortality after tricuspid surgery and cardiac surgery in general.3–7 In this case series, we aim to quantify the impact of hepatorenal dysfunction using MELD and evaluate its ability to predict operative mortality after triple valve surgery (TVS).