Preoperative Albumin–Bilirubin (ALBI) Score Is the Strongest Predictor of Mortality After LVAD Implantation

<b>Background:</b> Patients with end-stage heart failure (HF) undergoing left ventricular assist device (LVAD) implantation remain at significant risk of post-implant mortality. Identifying preoperative predictors of adverse outcomes may improve risk stratification. The aim of the study was to search for factors associated with worse prognosis after LVAD implantation during the long-term follow-up. <b>Methods:</b> This single-center, retrospective study included 95 patients who underwent HeartMate III LVAD implantation between 2016 and 2024. Indications for implantation included bridge to transplant, bridge to recovery, or destination therapy. Pre-implant clinical data, pharmacological treatment, echocardiographic parameters, and laboratory profiles were collected. Albumin-bilirubin (ALBI) score was calculated as the marker of liver dysfunction. The primary end-point was all-cause mortality during the long-term follow-up. <b>Results:</b> The median age was 57.9 years (IQR: 47.2-63.8), and 91.6% were male. During follow-up (835 (250-1973) days), 46 patients (48.4%) died. In multivariable weighted Cox analysis, higher serum creatinine level (HR 3.403 per 1 µmol/L <i>p</i> < 0.001), higher ALBI score (HR 4.981 per 1-unit increase; <i>p</i> < 0.001) and older age (1.04 per year, <i>p</i> < 0.01) remained independent predictors of mortality. <b>Conclusions:</b> Among patients undergoing HeartMate III LVAD implantation, higher creatinine concentrations, higher preoperative ALBI score and older age were independently associated with all-cause mortality. These parameters may be useful for risk stratification during long-term follow up.