MELD AND MELD-BASED SCORE AS POTENTIAL EARLY MARKER OF VISCERAL MALPERFUSION IN PATIENTS WITH ACUTE AORTIC DISSECTION

Introduction: Acute aortic dissection of the ascending aorta carries a very high early mortality up to 1%-2% /h in untreated symptomatic patients. Immediate surgical treatment, therefore, has been considered so far the gold standard in such conditions. The relevance of preoperative peripheral malperfusion in postoperative outcome, however has been recently pointed out suggesting the option for a primary stabilization of peripheral (especially visceral) malperfusion. The diagnosis of clinically significant visceral malperfusion, however, is still unclear and often underdiagnosed. Here we evaluate the potential of using MELD and MELD- based scores, as marker of significant malperfusion, in preoperative prediction of postoperative in-hospital mortality Materials and Methods: 160 patients undergoing surgical repair of acute aortic dissection over a 10-year period with a complete preoperative blood analysis recorded in our system were retrospectively enrolled in this study. Preoperative MELD (Model for End stage Liver Disease) a simple preoperative score, calculated from 3 biochemical variable, and MELD-based scores were calculated and a potential correlation with postoperative mortality was analysed. Results: Overall In-hospital Mortality was 16,8%. MELD Score ranged between 3 and 26. Overall MELD score was significantly higher in patients who died postoperatively, especially in male patients. Furthermore Meld >8 was predictive risk factor for in-hospital postoperative mortality. MELD-based scores were higher in death patients without statistical significance. Discussion: In conclusion MELD score could represent a simple method to predict postoperative mortality in case of acute aortic syndrome, detecting early signs of visceral malperfusion, potentially amenable of an “abdomen first” treatment.