Impact of Obesity on Ventricular Assist Device Outcomes

Jaiswal, Abhishek; Truby, Lauren K.; Chichra, Astha; Jain, Rashmi; Myers, Leann; Patel, Nirav; Topkara, V.K.

doi:10.1016/j.cardfail.2019.10.001

Cited by 28 publications

(12 citation statements)

References 50 publications

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“…Because obesity remains a relative contraindication to HT, obese patients with advanced HF may receive an LV assist device (LVAD) as destination therapy or bridge to weight loss in order to become listed for HT. Jaiswal et al 73 analyzed data from 2620 patients from the interagency registry for mechanically assisted circulatory support (INTERMACS) who had BMI ≥ 35 kg/m 2 , finding that these patients tended to be young, non-white females with dilated cardiomyopathy and received an LVAD as destination therapy. Survival was similar among BMI groups, however, obese patients had significantly higher risk for infection, device malfunction or thrombosis, cardiac arrhythmia and hospital readmissions, but lower bleeding risk.…”

Section: Left Ventricular Assist Devicementioning

confidence: 99%

Implications of obesity across the heart failure continuum

Elagizi

Carbone

Lavie

et al. 2020

Progress in Cardiovascular Diseases

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The obesity paradox, which suggests a survival advantage for the obese in heart failure (HF) has sparked debate in the medical community. Studies demonstrate a survival advantage in obese patients with HF, including those with advanced HF requiring continuous inotropic support for palliation or disease modifying therapy with a left ventricular assist device (LVAD) or heart transplantation (HT). Importantly, the obesity paradox is affected by the level of cardiorespiratory fitness (CRF). It is now recommended that HF patients with body mass index ≥35 kg/m 2 achieve at least 5–10% weight loss, in order to improve symptoms and cardiac function, though more robust data are urgently needed. CRF may be the single best predictor of overall health and small improvements in fitness levels may lead to improved outcomes in HF. In addition to implications of obesity in chronic HF, we also discuss management of obese patients with advanced HF and their implications for therapies such as LVAD implantation and HT.

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Section: Left Ventricular Assist Devicementioning

confidence: 99%

Implications of obesity across the heart failure continuum

Elagizi

Carbone

Lavie

et al. 2020

Progress in Cardiovascular Diseases

View full text Add to dashboard Cite

show abstract

“…9 Considering the role that BMI has, in transplant candidacy, appropriate weight control now becomes an important factor for successful transplant. 23 The role of bariatric surgery in heart failure patients, specifically LVAD patients and transplant candidates, is growing. Prior to implantation, it is possible for patients to consult with a bariatric surgeon and complete prerequisites required for bariatric surgery candidacy, either during LVAD candidacy evaluation or after implantation.…”

Section: Discussionmentioning

confidence: 99%

Isolated left ventricular assist device implantation produces variable changes to patient body mass index

et al. 2022

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Background Body mass index (BMI) is an important consideration for transplant‐eligible left ventricular assist device (LVAD) recipients. LVAD therapy’s impact on BMI is unclear. We evaluated BMI changes in patients who underwent LVAD implantation. The association between these patients’ BMI and the transplant was studied. Methods This was a retrospective cohort study of patients who underwent LVAD implantation between January 1, 2012 and December 31, 2018 at our institution. Patients were stratified by preoperative BMI (kg/m2) into four groups: <30, 30–34.9, 34.9–39.9, and ≥40. BMI data were collected at 12 and 6 months prior to implantation, time of implantation, and 3‐ and 6‐ months postimplantation. Results A total of 107 patients underwent LVAD implantation at our institution. Data were available for 80 patients. Baseline characteristics included a mean age of 56.0 years, 69% male, and a mean implant BMI of 29.9 ± 6.8 kg/m2. The mean BMI (kg/m2) for each of the BMI (kg/m2) groups <30, 30–34.9, 35–39.9, and ≥40 (n = 60, 25, 12, and 10, respectively) was 25.1, 32.5, 36.8, and 43.8, respectively. There was no consistent pattern with weight change across differing implant BMIs. No patient with a BMI of <30 gained sufficient weight to impact transplant candidacy. Twenty‐three percent of patients with a BMI of 30–34.9 kg/m2, 60% of patients with a BMI of 35–39.9 kg/m2, and 87.5% of patients with a BMI of ≥40 kg/m2 had a 6‐month BMI potentially affecting transplant. Conclusions Associated weight changes during LVAD support may significantly impact transplant candidacy. Higher BMI groups may benefit from multimodal and multidisciplinary targeted weight‐loss interventions.

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“…Although exercise tolerance often improves too, it remains limited when compared to healthy subjects [2]. These factors, in addition to other comorbidities like depression, lead to weight gain after VAD implantation, especially in those patients with BMI < 35 kg/m 2 [3]. The latter situation could lead to many obese patients with VADs as bridge to HT being deemed unsuitable candidates once they reach a BMI ≥ 35 kg/m 2 .…”

Section: Objectivementioning

confidence: 99%

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note

et al. 2020

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Objectives Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA. Data description This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m2, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.

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Impact of Obesity on Ventricular Assist Device Outcomes

Cited by 28 publications

References 50 publications

Implications of obesity across the heart failure continuum

Implications of obesity across the heart failure continuum

Isolated left ventricular assist device implantation produces variable changes to patient body mass index

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note

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