Coronary artery bypass grafting versus drug-eluting stents in patients with end-stage renal disease.

BACKGROUND: The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved. AIM OF STUDY: Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD. METHODS: MEDLINE, Web of Science, and Scopus were searched for appropriate studies published in the English language (between January 2000 and August 2013). The pooled odds ratio (OR) was estimated by the Peto method with a random effect model. Data are presented with 95% confidence interval; p<0.05 is significant. RESULTS: Five observational studies (12,035 DES patients; 6317 CABG) with a follow-up period of 27.4 ± 6.3 months were included. Early mortality (CABG 8% and DES 2.6%) was less in the DES cohort (OR 0.29 [0.14-0.59]; p=0.0006; I(2)=18%). Repeat intervention (DES 29% and CABG 12%) was more likely in the DES cohort (OR 3.72 [2.24-6.18]: p<0.0001). Late mortality (27.4 ± 7.3 months) was comparable in both cohorts (OR 0.72 [0.40-1.29]; p=0.27). While DES cohort (32%) patients suffered a slightly higher incidence of major adverse cardiac and cerebrovascular events (MACCE) as compared to CABG (25%), this was not significant (1.35 [0.72-2.53]; p=0.35; I(2)=30%). CONCLUSION: Data regarding this topic are limited to small retrospective studies. Early mortality is lower with DESs compared with coronary artery bypass in patients with ESRD. Rate of reintervention is significantly higher in the DES cohort. At a mean pooled follow-up of two years, both mortality and MACCE are comparable in both cohorts.

Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices.

INTRODUCTION: Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. AIM: Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. RESULTS: From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51±11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53±12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p=0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p=0.25). Estimated late survival in the BTx cohort was 94±7, 90±10 and 83±16% at the end of one, two and three years, respectively which was comparable to 97±4%, 93±6% and 89±9% for the Tx group (p=0.50). CONCLUSION: Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation.

Hepatic and renal function with successful long-term support on a continuous flow left ventricular assist device.

INTRODUCTION: Data regarding the long-term clinical effects of a continuous flow left ventricular assist device (CF-LVAD) on hepato-renal function is limited. Hence our aim was to assess changes in hepato-renal function over a one-year period in patients supported on a CF-LVAD. METHODS: During the study period 126 patients underwent CF-LVAD implant. Changes in hepato-renal laboratory parameters were studied in 61/126 patients successfully supported on a CF-LVAD for period of one year. A separate cohort of a high-risk group (HCrB) of patients (56/126) with a serum creat>1.9 mg/dL (168 µmol/L) (75th percentile) or a serum bil>1.5 mg/dL (25.65 µmol/L) (75th percentile) was created. Changes in serum creatinine and bilirubin were analysed at regular intervals for this group along with the need for renal replacement therapy. RESULTS: Baseline creatinine and blood urea nitrogen (BUN) for the entire cohort was 1.4[1.2,1.9 mg/dL] [123.7(106,168) µmol/L) and 27[20,39.5 mg/dL] [9.6(7.1,14.1) mmol/L] respectively. After an initial reduction at the end of one month [1(0.8,1.2) mg/dL; 88(70,105) µmol/L] (p<0.0001), a gradual increase was noted over the study period to reach (1.25[1.1,1.5] mg/dL; 106(97.2,132.6) µmol/L] (p=0.0003). The serum bilirubin normalised from a [1(0.7,1.55) mg/dL] [17(18.8,25.7) µmol/L) to 0.9(0.6,1.2)mg/dL [15.4(10.2,20.5) µmol/L] (p=0.0005) and continued to decline over one year. Improvement in the synthetic function of the liver was demonstrated by a rise in the serum albumin levels to reach 4.3[4.1,4.5] [43(41,45) gm/L] at the end of one year (p<0.0001). The baseline serum creatinine and bilirubin for the high-risk cohort (HCrB) was 1.9(1.3,2.4) mg/dL [168(115,212) µmol/L] and 1.7(1.00,2.4) mg/dL [29(17.1,68.4) µmol/L] respectively. The high-risk cohort (HCrB) demonstrated a trend towards higher 30-day mortality (p=0.06). While the need for temporary renal replacement therapy was higher in this cohort (16% vs. 4%; p=0.03), only 3% need it permanently. A significant reduction in creatinine was apparent at the end of one month [1.1(0.8,1.4) mg/dL; 97(70.7,123.7) µmol/L] (p<0.0001) and then remained stable at [1.3(1.1,1.5) mg/dL; 115(97,132.6) µmol/L]. Bilirubin demonstrated a 30% decline over one month and then remained low at [0.7(0.5,0.8) mg/dL; 62(44,70) µmol/L] p=0.0005 compared to the pre-operative baseline. CONCLUSION: Hepato-renal function demonstrates early improvement and then remains stable in the majority of patients on continuous flow left ventricular assist device support for one year. High-risk patients demonstrate a higher 30-day mortality and temporary need for renal replacement therapy. Yet even in this cohort, improvement is present over a period of one year on the device, with a minimal need for permanent haemodialysis.

Dual anti-platelet therapy after coronary artery bypass grafting: is there any benefit? A systematic review and meta-analysis.

BACKGROUND: Anti-platelet therapy is an important component of medical therapy post coronary artery bypass grafting (CABG). While aspirin administration is a Class I indication after CABG, the benefit of concomitant clopidogrel is a controversial issue. METHODS: We searched OVID Medline, Cochrane, Scopus, and EMBASE for randomized control trials and observational studies comparing aspirin ± placebo to aspirin + clopidogrel after CABG. RESULTS: Eleven articles (five randomized control trials and six observational studies) including 25,728 patients met inclusion criteria. Early saphenous vein graft occlusion was reduced with the use of dual anti-platelet therapy (risk ratio (RR) = 0.59, 95% CI 0.43-0.82, p = 0.02). In-hospital or 30-day mortality was lower with aspirin + clopidogrel (0.8%) compared to aspirin alone (1.9%) (p < 0.0001), while risk of angina or perioperative myocardial infarction was comparable (RR = 0.60, 95% CI 0.31-1.14, p = 0.12). Patients treated with aspirin + clopidogrel demonstrated a trend towards a higher incidence of major bleeding episodes as compared to patients treated with aspirin alone (RR = 1.17, 95% CI 1.00-1.37, p = 0.05). In a pooled analysis of studies involving off-pump CABG compared to aspirin alone, dual anti-platelet therapy reduced the risk of perioperative myocardial infarction and saphenous graft occlusion by 68% (47% to 71%) and 55% (2% to 79%) respectively. CONCLUSION: Dual anti-platelet therapy after CABG improved early saphenous vein graft patency, but may increase the risk of bleeding. The use of dual anti-platelet therapy appears to be most beneficial in patients undergoing off-pump CABG. Prospective randomized studies are necessary to determine whether this beneficial effect of dual therapy is also achieved in patients undergoing on pump CABG.

Myocardial revascularisation in renal dysfunction: a systematic review and meta-analysis.

BACKGROUND: Coronary artery disease is highly prevalent in patients with end-stage renal disease. Yet randomised controlled trials are lacking, and decisions are based on retrospective cohort studies which present conflicting outcomes. Hence we conducted a systematic review and meta-analysis comparing outcomes in patients with end-stage renal disease and renal dysfunction undergoing percutaneous intervention (PCI) and coronary artery bypass grafting (CABG), with a particular focus on contemporary studies implementing drug-eluting stents. METHODS: MEDLINE, EMBASE, World of Science, and the Cochrane library were searched for randomised controlled (RCT) and observational studies comparing clinical outcomes such as early mortality, myocardial infarction, need for repeat revascularisation and angina in patients undergoing PCI or CABG. We used random effect models to compare risk ratios (RR) within groups. RESULTS: One RCT and 15 observational studies (7588 PCI and 9206 CABG patients) met inclusion criteria. Early mortality favoured the PCI cohort (4.2% vs 8.5%) [risk ratio=0.51(0.40, 0.64), p<0.01]. The need for repeat revascularisation was significantly lower in the CABG cohort (7.3% vs 17.8%; p<0.01). Pooled analysis of studies implementing a drug eluting stent still favoured CABG with regards to repeat revascularisation (5% vs 14%; p<0.01) and MACE (15% vs 27%; p=0.03), while early mortality was less in the DES-PCI cohort (2.4% vs 5.1%; p=0.04). CONCLUSION: Compared to percutaneous intervention, coronary artery bypass grafting is associated with higher early/30-day mortality in patients with renal dysfunction or end-stage renal disease. The need for repeat revascularisation is significantly higher with percutaneous intervention, even with the use of a drug-eluting stent.

Concomitant tricuspid valve repair or replacement during left ventricular assist device implant demonstrates comparable outcomes in the long term.

INTRODUCTION: Severe tricuspid regurgitation (TR) is present in nearly half the patients undergoing implant of a left ventricular assist device (LVAD) and its correction confers better long-term outcome. AIM: To compare the early and late results of tricuspid valve repair (TVrpr) or replacement (TVR) with LVAD implant. PATIENT AND METHODS: Sixty-four from a cohort of 126 patients had a concomitant tricuspid valve procedure; 48 (75%) underwent a TVrpr whereas 16 (25%) had TVR. All preoperative hemodynamic parameters including the mean TR grade (TVrpr; 3.6 vs. TVR; 3.7) were comparable (p = 0.7). The mean TR grade was 1.6 ± 1.5 for the remaining 62 patients who did not have a concomitant tricuspid valve procedure, with 4/62 (6%) having severe TR (p < 0.0001). RESULTS: Cardiopulmonary bypass time was longer for patients undergoing TVR (p = 0.01). There was a significant reduction in right atrial pressure for the entire cohort (p < 0.01) and the postoperative right atrial pressure was not statistically different between TVrpr (13.6 ± 4.6) and TVR (11.6 ± 4.3; p = 0.6. Postoperative intensive care unit stay was comparable as was the duration of inotropic support (p = 0.5) or need for temporary right ventricular mechanical support. In-hospital mortality (12%) was not different between groups. The mean time for LVAD support was 12.3 ± 9.71 months and the last transthoracic echocardiographic examination was performed at mean intervals of 13.8 ± 10.8 months (TVrpr) and 11.8 ± 7.6 months (TVR; p = 0.47). Reduction in TR grade was similar between groups (p = 0.27). Late mortality (p = 1.00) was comparable in both groups. Using log-rank analysis, there was no significant difference in the estimated survival between TVrpr and TVR (p = 0.88). CONCLUSION: TVrpr repair at the time of LVAD implant is effective in correcting TR even at the end of one year of follow-up. The choice to repair or replace does not affect the clinical outcome.

Pathophysiology and Management of Pulmonary Embolism.

Pulmonary embolism (PE) is one of the most common etiologies of cardiovascular mortality. It could be linked to several risk factors including advanced age. The pathogenesis of PE is dictated by the Virchow's triad that includes venous stasis, endothelial injury, and a hypercoagulable state. The diagnosis of PE is difficult and is often missed due to the nonspecific symptomatology. Hypoxia is common in the setting of PE, and the degree of respiratory compromise is multifactorial and influenced by underlying cardiac function, clot location, and ability to compensate with respiratory mechanics. Right ventricular dysfunction/failure is the more profound cardiovascular impact of acute PE and occurs due to sudden increase in afterload. This is also the primary cause of death in PE. High clinical suspicion is required in those with risk factors and presenting signs or symptoms of venous thromboembolic disease, with validated clinical risk scores such as the Wells, Geneva, and pulmonary embolism rule out criteria in estimating the likelihood for PE. Advancement in capture time and wider availability of computed tomographic pulmonary angiography and D-dimer testing have further facilitated the rapid evaluation and diagnosis of suspected PE. Treatment is dependent on clinical presentation and initially involves providing adequate oxygenation and stabilizing hemodynamics. Anticoagulant therapy is indicated for the treatment of PE. Treatment is guided by presence or absence of shock and ranges from therapeutic anticoagulation to pharmacologic versus mechanical thrombectomy. The prognosis of patients can vary considerably depending on the cardiac and pulmonary status of patient and the size of the embolus.

Cardiac Myxomas: A 50-Year Experience With Resection and Analysis of Risk Factors for Recurrence.

BACKGROUND: Myxomas are the most common cardiac tumors, but there are insufficient data regarding long-term survival and recurrence rates. Our objective was to examine late results and attempt to determine a strategy for recurrence monitoring, as there are no recommended guidelines at present. METHODS: We performed a retrospective analysis of 194 patients (mean age 57.2 ± 15.6 years; 62.4% female) undergoing resection of cardiac myxoma from June 1955 to June 2011. The left atrium (n = 155, 80%) was the most common location, and the mean tumor size was 4.3 ± 2.1 cm by 3.2 ± 1.6 cm by 2.1 ± 1.3 cm. Dyspnea (n = 68) and palpitations (n = 57) were the most common complaints, and 28 patients (14.4%) were asymptomatic. RESULTS: The tumor was exposed through the respective atria in the majority of patients (n = 187). Bypass and cross-clamp times were 59.1 ± 33.4 minutes and 35.2 ± 21.7 minutes, respectively. Two thirds of the tumors were excised with an endocardial button, and the rest were resected at the base of the stalk. Operative mortality was 0.5%. Ten, 20 and 30-year survival was 77%, 52% and 34%, respectively, which was comparable to an age-matched general population (p = 0.191). Older age at operation was the only significant predictor of subsequent mortality (p < 0.001). There was no significant difference in survival when patients were stratified by sex (p = 0.784), location of tumor (p = 0.087), the largest tumor dimension (p = 0.257) or surgical technique (endocardial button versus base of the stalk, p = 0.502). Tumors recurred in 11 patients; freedom from tumor recurrence was 92%, 91%, and 86% at 10, 20, and 30 years, respectively. Younger age at surgery (hazard ratio 0.94, p = 0.002), smaller tumor dimension (hazard ratio 0.58, p = 0.011), and tumor localized to the ventricles (hazard ratio 7.29, p = 0.013) were predictors of recurrence. CONCLUSIONS: Cardiac myxomas can be resected with low early mortality and excellent late survival. Tumor recurrence is more likely to occur in the first 10 postoperative years, especially in younger patients, patients with a smaller tumor mass, or tumor location in the ventricle. Patients with these findings require closer imaging surveillance in the first decade after resection.

Long-term Outcomes and Prognostic Factors for Patients Requiring Renal Replacement Therapy After Cardiac Surgery.

OBJECTIVE: To examine long-term outcomes, including all-cause mortality, and the likelihood and timing of renal recovery among patients requiring renal replacement therapy (RRT) for acute kidney injury after cardiac surgery. PATIENTS AND METHODS: This is a single-center, historical, matched cohort study of post-cardiac surgery patients who required RRT from January 1, 2007, through December 31, 2012. We matched each case with 2 controls, each of whom did not require RRT after cardiac surgery, for age, sex, and type of surgery. The patients were followed up for 1 year after the start of RRT. The main outcomes were all-cause mortality in all patients and rate of renal function recovery in patients who required RRT. RESULTS: A total of 202 patients met the inclusion criteria. The unadjusted all-cause mortality among patients requiring RRT was 64% at 1 year vs 8% for matched controls. In multivariate analysis, the hazard ratio for all-cause mortality was 12.59 (95% CI, 8.24-19.68) for cases vs controls. Increased 1-year all-cause mortality was independently associated with increased age, a history of congestive heart failure, lower preoperative creatinine level, longer interval between surgery and starting RRT, and the need for mechanical ventilation or an intra-aortic balloon pump at the time of RRT. Renal recovery occurred in 34% of cases by 90 days and in 39% by 1 year. Of those who recovered renal function, 87% were within 90 days. Only 8 (4%) of the 186 patients were alive and continued to receive RRT at 1 year. CONCLUSIONS: The need for RRT after cardiac surgery is an independent risk factor for mortality. In the case of survival, the chance of renal recovery is reasonable.

Are two really always better than one? Results, concerns and controversies in the use of bilateral internal thoracic arteries for coronary artery bypass grafting in the elderly: a systematic review and meta-analysis.

INTRODUCTION: Bilateral internal thoracic artery grafting appears to be the preferred method to achieve durable long-term coronary artery revascularization. However, data reporting the benefit of this technique in the elderly is very conflicting. METHOD: We performed a systematic review of available literature (till November 2014) using multiple databases to identify studies comparing clinical events in patients undergoing coronary artery bypass grafting using either a single or double internal thoracic artery in the elderly. While early mortality was the primary end-point of inclusion, other adverse events compared were sternal wound infection (deep and superficial), stroke and peri-operative myocardial infarction. Individual and pooled odd's ratios were calculated using the Mantel-Haenzel method (random effect model); sensitivity analysis was performed. Results are presented using 95% confidence intervals. RESULT: Nine retrospective studies (4479 BITA, 7733 LITA patients) fulfilled search criteria. Deep sternal wound infection was significantly higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p = 0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p = 0.1) were comparable in both cohorts. Long-term survival favored the BITA cohort in two propensity matched studies. CONCLUSION: The incidence of deep sternal wound infection may be significantly higher after the harvest of both internal thoracic arteries in the elderly. While other post-operative adverse events are comparable, data regarding the long-term survival advantage in this cohort is conflicting. Hence, the use of both internal thoracic arteries in this age group needs to be invidualized.

De novo aortic insufficiency during long-term support on a left ventricular assist device: a systematic review and meta-analysis.

Aortic insufficiency (AI) may occur while supported on a left ventricular assist device (LVAD). We conducted a systematic review to determine the incidence, predictors, and consequences of AI during LVAD support. MEDLINE was searched for original studies presenting clinical data regarding patients who developed AI during LVAD implant. Seven observational studies (657 patients) were selected for review; 65% of patients underwent implantation with a continuous-flow device (Cf-LVAD). The incidence of AI was 25% (11-42%) (Support period: 412 ± 281 days). AI increased by 4% (1-6%) per month of support (p < 0.01). AI-positive patients were older at implant (weighted mean difference, 7.7 [4.3; 11.1]; p < 0.01). Female sex (0.002 ± 0.001; p = 0.01) and smaller body surface area (-0.003 ± 0.001 per m; p < 0.01) correlated with progressive AI. Destination therapy patients (odds ratio [OR], 5.3 [1.2, 24]; p = 0.02) and those with Cf-LVAD pumps were likely to develop AI (hazard ratio [HR], 2.2 [1.2, 3.8]; p < 0.01). A closed aortic valve was associated with AI (OR, 4.7 [1.9, 11.8]; p < 0.01). Survival was comparable in both cohorts (HR, 1.5 [0.81, 2.8]; p = 0.2). A significant number of patients develop de novo AI during LVAD support. Advanced age, longer support duration, continuous-flow pumps, and a closed aortic valve are associated with AI. Large cohort studies would improve our understanding of this condition.

Minimally invasive direct coronary artery bypass graft surgery or percutaneous coronary intervention for proximal left anterior descending artery stenosis: a meta-analysis.

BACKGROUND: We conducted a metaanalysis comparing early and midterm cardiovascular adverse events associated with minimally invasive direct coronary artery bypass graft surgery (MIDCABG) and percutaneous coronary intervention (PCI), with a focus on drug-eluting stents (DES). METHODS: A systematic literature review (MEDLINE, EMBASE, Scopus, and so forth) yielded 12 studies (7 randomized controlled trials; 5 observational) pooling more than 2,000 patients. A random effect, inverse variance metaanalysis was conducted, and a subgroup analysis of the PCI-DES cohort was performed. Events were compared as risk ratios using a 95% confidence interval (CI). Heterogeneity of results was evaluated by Eggers I(2) test. Results are presented as early (0 to 1 year) and midterm (2 to 5 years). RESULTS: Midterm mortality in the PCI and MIDCABG groups (3.6% and 2.6%, respectively) was comparable (1.24, 95% CI: 0.66 to 2.33; p = 0.5; I(2) = 0%). Risk of early restenosis was lower in the MIDCABG cohort compared with PCI (0.40, 95% CI: 0.16 to 0.99; p = 0.05; I(2) = 57%). Although the early risk of recurrence of angina was comparable, over time it was 61% (43% to 74%) lower for MIDCABG patients (p < 0.001). Midterm results on analysis of the entire cohort demonstrated an increased risk for target vessel reinterventions (3.84, 95% CI: 2.7 to 5.5; p < 0.001) in the PCI cohort. Subgroup analysis revealed that the PCI-DES cohort (4 studies; 456 patients) had a higher risk of recurrent angina (risk ratio 3.4, 95% CI: 1.9 to 6.2; p < 0.001; I(2) = 0%) and target vessel reinterventions (risk ratio 4.16, 95% CI: 2.7 to 6.6; p < 0.001; I(2) = 0%) at midterm follow-up (2 to 5 years). CONCLUSIONS: Survival rates are comparable after either MIDCABG or PCI for proximal LAD disease. However, even the use of DES was associated with significantly higher rates of angina recurrence and the need for target vessel reintervention as compared with MIDCABG.

Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients.

BACKGROUND: Coronary artery bypass graft surgery is superior to percutaneous intervention in diabetic patients with multivessel disease. The use of bilateral internal thoracic arteries (BITA) may provide better long-term graft patency, but the risk of postoperative deep sternal wound infection has limited its use in diabetic patients. However, studies have reported conflicting results, and require systematic evaluation. METHODS: MEDLINE, EMBASE, World of Science, and the Cochrane library were searched for randomized controlled trials and observational studies comparing the incidence of deep sternal wound infection in diabetic patients undergoing either left internal thoracic artery (LITA) or BITA harvest. We used random effect models to compare risk ratios within groups. RESULTS: One randomized controlled trial and 10 observational studies (126,235 diabetic patients: 122,465 LITA, 3,770 BITA) met inclusion criteria. Deep sternal wound infection occurred in 3.1% and 1.6% for the BITA and LITA cohorts, respectively. The risk ratio for deep sternal wound infection development was 1.71 (1.37 to 2.14) for BITA compared with LITA. Patients who underwent skeletonized BITA harvest had a similar risk of deep sternal wound infection compared with LITA (0.9 [0.42 to 2.09]), although pedicled harvest demonstrated increased risk (1.77 [1.4 to 2.23]). Early mortality was comparable in the LITA cohort (2.5%) and the BITA cohort (2.3%; p = 0.8). CONCLUSIONS: The risk of deep sternal wound infection can be minimized in diabetic patients undergoing coronary artery bypass graft surgery by performing ITA harvested in a skeletonized manner with meticulous attention to preserving sternal blood flow. Pedicled harvest is to be discouraged when utilizing both ITA owing to a significant increase in the risk of postoperative deep sternal wound infection.

Predictive value of the model for end-stage liver disease score in patients undergoing left ventricular assist device implantation.

Axial flow left ventricular assist device (LVAD) implantation is an effective therapy for patients with advanced heart failure. As the preoperative hepatic and renal function play a critical role in determining adverse events after LVAD implantation, we analyzed the predictive role of the model for end-stage liver disease (MELD) score in determining in-hospital mortality after surgery. One hundred twenty-six patients underwent implant of an LVAD at our institution. Their individual preoperative MELD scores and perioperative total blood product usage (TBPU) were calculated. As LVAD implant as a reoperation is known to influence postoperative bleeding and mortality independently, the patients were divided into group I (first cardiac surgery) and group II (reoperative surgery). Group I: LVAD implantation was performed in 68/126 (54%) patients as their first cardiac surgery. The mean MELD score was 16.3 ± 6. Median TBPU for this group was 20.7 (0, 135) units. Inhospital mortality/30-day mortality was 4/68 (5.8%). Increasing MELD score (c-statistic = 0.88) and TBPU were found to be predictors of early mortality. An increasing MELD score was associated with more TBPU (p < 0.01) with a 10.9 ± 3 TBPU increase per a 10 unit rise in the MELD score. Group II: Of the 126 patients, 58 (46%) underwent LVAD implantation as a reoperation. Mean MELD score for these patients was 16 ± 5. Inhospital mortality/30-day mortality in this group was 12% and median TBPU was 30 (4,153) units. The MELD score was not predictive of inhospital mortality in these patients (p = 0.97). The MELD score is predictive of early mortality in patients undergoing LVAD implantation as their first cardiac surgery. Use of this score to select patients for LVAD implantation may be appropriate.