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).