{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:42:55Z","timestamp":1788514975970,"version":"build-2803163510"},"reference-count":24,"publisher":"BMJ","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2013,1,10]]},"published-print":{"date-parts":[[2013,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The Fontan operation is a staged palliation for complex congenital heart disease and single ventricle physiology. Perioperative survivors of the Fontan operation experience long-term cardiac complications, including death. Liver and renal dysfunction are reported in these patients and have a direct effect on morbidity and mortality. This study aims to investigate whether the Model for End-stage Liver Disease eXcluding INR score (function of creatinine and total bilirubin, MELD-XI) predicts risk for cardiac mortality or transplantation in patients with Fontan circulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Retrospective, single-centre study. Time of first evaluation was the time of the earliest available MELD-XI score measurement, and follow-up was terminated by a cardiac event or by the last clinical evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Patients surviving after Fontan surgery and evaluated at Boston Children's Hospital between 1993 and 2008.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>Composite endpoint of sudden death, death from congestive heart failure or cardiac transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The MELD-XI score was calculated as MELD-XI=11.76(log\n                      <jats:sub>e<\/jats:sub>\n                      creatinine)+5.112(log\n                      <jats:sub>e<\/jats:sub>\n                      total bilirubin)+9.44. Ninety-six patients were included (52 male, median age 26\u2005years). After a mean follow-up period of 5.7\u2005years, 18 patients (19%) experienced the composite end point. Baseline MELD-XI score was independently and directly related to the incidence of the composite endpoint (HR for high MELD-XI score group of 7.76, 95% CI 2.05 to 29.33, p=0.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fontan patients with a higher MELD-XI score have shorter freedom from sudden cardiac death, death from congestive heart failure and cardiac transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2012-303347","type":"journal-article","created":{"date-parts":[[2013,2,13]],"date-time":"2013-02-13T21:22:33Z","timestamp":1360790553000},"page":"491-496","source":"Crossref","is-referenced-by-count":167,"title":["MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery"],"prefix":"10.1136","volume":"99","author":[{"given":"Gabriele Egidy","family":"Assenza","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, \u201cSapienza Universita\u2019 di Roma\u201d University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne A","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Landzberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Marie","family":"Valente","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael N","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamir","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koenraad J","family":"Mortele","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinweike","family":"Ukomadu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical 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