Cardiac Intervention Outcomes in Patients With Liver Disease and the Predictive Value of MELD 3.0

Abstract

Liver dysfunction is associated with increased perioperative complications, yet its impact on cardiac surgery outcomes remains unclear. This retrospective analysis of 500 patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR) at DHMC evaluated postoperative complications, length of stay, and 60-day mortality in relation to documented liver disease and preoperative MELD 3.0 scores. Contrary to expectations, patients with a history of liver disease did not exhibit higher complication rates or longer hospitalizations within either treatment modality. SAVR consistently produced greater morbidity and longer stays than TAVR, reflecting procedural invasiveness rather than hepatic status. When stratified by MELD 3.0 severity, higher scores did not correlate with increased complications or prolonged hospitalization, but did show a stepwise rise in 60-day mortality, suggesting that hepatic dysfunction contributes most significantly to early postoperative mortality risks. Limited numbers of patients with confirmed cirrhosis in the initial sample reduced power to detect associations. A larger, targeted cohort of ~2,500 additional cases is planned to better evaluate how advanced liver disease influences selection of cardiac intervention and postoperative outcomes.