Obesity as a Risk Factor for Consideration for Left Ventricular Assist Devices

Mohamedali, Burhan; Yost, Gardner; Bhat, Geetha

doi:10.1016/j.cardfail.2015.06.006

Cited by 33 publications

(31 citation statements)

References 37 publications

(19 reference statements)

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“…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. We observed higher rates of stage 2/3 AKI and PT in the extremely obese cohort, which is in agreement with prior studies .…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2019

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Left ventricular assist devices (LVADs) have improved clinical outcomes and quality of life for those with end‐stage heart failure. However, the costs and risks associated with these devices necessitate appropriate patient selection. LVAD candidates are becoming increasingly more obese and there are conflicting reports regarding obesity’s effect on outcomes. Hence, we sought to evaluate the impact of extreme obesity on clinical outcomes after LVAD placement. Consecutive LVAD implantation patients at our center from June 2008 to May 2016 were studied retrospectively. We compared patients with a body mass index (BMI) ≥40 kg/m2 (extremely obese) to those with BMI < 40 kg/m2 with respect to patient characteristics and surgical outcomes, including survival. 252 patients were included in this analysis, 30 (11.9%) of whom met the definition of extreme obesity. We found that patients with extreme obesity were significantly younger (47[33, 57] vs. 60[52, 67] years, P < 0.001) with fewer prior sternotomies (16.7% vs. 36.0%, P = 0.04). They had higher rates of pump thrombosis (30% vs. 9.0%, P = 0.003) and stage 2/3 acute kidney injury (46.7% vs. 27.0%, P = 0.003), but there were no differences in 30‐day or 1‐year survival, even after adjusting for age and clinical factors. Extreme obesity does not appear to place LVAD implantation patients at a higher risk for mortality compared to those who are not extremely obese; however, extreme obesity was associated with an increased risk of pump thrombosis, suggesting that these patients may require additional care to reduce the need for urgent device exchange.

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Section: Discussionsupporting

confidence: 90%

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

et al. 2019

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“…20 Several studies since then, the largest of which used data from 896 HeartMate II trial patients, also showed no decrease in survival among obese LVAD patients as far out as 3 years after implantation. 5- 7 Although obesity has not been found to adversely affect survival, it has been linked with a number of VAD-related complications. A large study by Boyle et al identified BMI as an independent risk factor for post-discharge bleeding, ischemic stroke and pump thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Higher Body Mass Index Increases Risk of HeartMate II Pump Thrombosis But Does Not Adversely Affect Long-Term Survival

Han

Sooppan

Johnson

et al. 2017

Circ J

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Background: Obesity has been correlated with various adverse events in patients who receive left ventricular assist devices (LVAD). In this study, we sought to further characterize the role of obesity in this patient population. Methods and Results:We performed a retrospective analysis of 164 patients implanted with a HeartMate II from August 2008 to December 2014. Patients were categorized into 2 BMI groups based on WHO guidelines: BMI 18.5-30 kg/m 2 (n=99) and BMI >30 kg/m 2 (n=65). Patient demographics, adverse outcome and long-term survival were compared between the 2 groups. For any outcome associated with BMI groups, we performed a Cox regression to identify confounding comorbidities. Preoperative demographics and comorbidities were similar. Patients with BMI >30 were younger (P=0.01) and had a higher incidence of type 2 diabetes (P=0.01). While rate of pump thrombosis was higher among patients with BMI >30 (P=0.02), overall survival at 2 years did not differ. The most common cause of death was hemorrhagic stroke in the obese group. On multivariable cox regression analysis, BMI was an independent risk factor of pump thrombosis. Conclusions:Higher BMI does not reduce survival after VAD implantation but it does appear to increase the risk of pump thrombosis. Further studies to characterize the role of BMI in survival and thrombosis rates are warranted.

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“…Several studies have indicated that obese patients may have increased rates of LVAD thrombosis and infections, but have survival rates similar to normal and underweight patients. These reports have generated varied results, and as a result, selection and management of LVAD patients with high BMIs remains challenging (7)(8)(9). At present there is only one other published study which investigated outcomes in patients with BMI ≥35 kg/m 2 (10).…”

Section: Original Articlementioning

confidence: 99%

The impact of extreme obesity on outcomes after left ventricular assist device implantation

et al. 2017

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Obesity as a Risk Factor for Consideration for Left Ventricular Assist Devices

Cited by 33 publications

References 37 publications

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

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

Higher Body Mass Index Increases Risk of HeartMate II Pump Thrombosis But Does Not Adversely Affect Long-Term Survival

The impact of extreme obesity on outcomes after left ventricular assist device implantation

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