Effect of obesity on outcomes in patients undergoing implantation of continuous-flow left ventricular assist devices

Abstract

The purpose of this study was to analyze the effect of obesity on outcomes after continuous-flow left ventricular assist device (CF-LVAD) implantation. A single-center retrospective analysis was performed on 526 chronic heart failure patients who were implanted with the HeartMate II CF-LVAD (n = 403) or HeartWare HVAD (n = 123) between November 2003 and March 2016. Patients were stratified into 4 groups based on BMI: underweight (< 18.5 kg/m, n = 18, 3.4%), normal-weight (18.5-25 kg/m, n = 173, 32.9%), overweight (25-30 kg/m, n = 182, 30.2%), and obese (> 30 kg/m, n = 153, 33.5%). The underweight group was excluded because of its small sample size. Records were reviewed to determine the incidence of postoperative complications and survival. Survival at 1, 6, 12, and 24 months were similar among normal-weight (91.3, 84.4, 76.3, and 67.6%), overweight (90.4, 80.8, 76.5, and 69.6%), and obese patients (90.7, 74.7, 65.3, and 61.3%, p = 0.24). Additionally, obesity was not a significant predictor of mortality in Cox proportional hazard models (hazard ratio 0.98, 95% confidence interval 0.766-1.277, p = 0.13). These findings suggest that appropriately selected obese patients receive similar survival benefit from CF-LVADs compared to non-obese patients, and obesity should not serve as a contraindication to CF-LVAD implantation.

Durable left ventricular assist device implantation in extremely obese heart failure patients

“…The increasing incidence and prevalence of obesity is accompanied by life‐limiting comorbidities including the metabolic syndrome, pulmonary hypertension, hypercoagulable state, atherosclerotic disease, arrhythmias, and HF. Our work confirms the results of several recent studies, which failed to detect a significant difference in short‐term and intermediate postoperative survival between obese and nonobese LVAD recipients . However, higher rates of hospital readmissions and complications such as AKI , infection , thromboembolism , and PT are often present in the obese cohort.…”

Effect of obesity on outcomes in patients who undergo implantation of a continuous-flow left ventricular assist device

“…Our study found that obesity alone was not an independent risk factor for mortality in patients who underwent CF-LVAD implantation [1]. Other groups also have reported that obesity does not seem to be a risk factor for mortality in LVAD patients [2,3].…”

Methylene Blue Does Not Improve Vasoplegia After Left Ventricular Assist Device Implantation

“…Body mass index was not expected to affect survival, and the statistical differences in creatinine and albumin were not considered clinically significant. 18,19 We observed higher individual vasopressor requirements in the MB group after PSIPW, although the differences were not statistically significant. Although matching based on individual pressor requirements is preferable, the small sample of eligible patients made matching by VIS preferable in this instance.…”