Outcomes Associated with Obesity in Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis

Abstract

Current data suggest that obesity does not impact survival, but may predispose patients to a higher rate of adverse events during left ventricular assist device (LVAD) support. We performed a systematic review and meta-analysis to assess the effects of obesity on clinical outcomes in LVAD recipients. We searched Medline, Scopus, Cochrane library, and clinicaltrials.gov from inception to February 2019 for studies comparing outcomes in obese (body mass index [BMI]> or ≥30 kg/m2) and nonobese (BMI< or ≤30 kg/m2) heart failure (HF) patients after LVAD implantation. Our primary endpoint was short-term (≤1 year) and long-term (>1 year) all-cause mortalities. The estimates are presented as random-effects risk ratios (RR) with 95% confidence intervals. In this meta-analysis of 15 observational studies (n = 26,842), obese patients receiving LVAD had significantly decreased 6 months (RR = 0.79 [0.73, 0.86]; p < 0.001, I 2 = 0%) and 1 year all-cause mortality (RR = 0.87 [0.79, 0.97]; p = 0.008, I 2 = 69%) compared with nonobese patients. However, both groups showed no significant difference in all-cause mortality at 2 years (RR = 0.95 [0.87, 1.04]; p = 0.12, I 2 = 55%) or 3 years (RR = 0.84 [0.61, 1.15]; p = 0.28, I 2 = 43%). Obese patients had significantly higher risk of device-related infections (RR = 1.48 [1.25, 1.75]; p < 0.001, I 2 = 37%), right heart failure (RR = 1.41 [1.21, 1.65]; p < 0.001, I 2 = 28%), and pump thrombosis (RR = 1.55 [1.37, 1.76]; p < 0.001, I 2 = 0%) compared with nonobese patients. This meta-analysis suggests that obese patients with HF have short- but not long-term survival benefit after LVAD implantation when compared to nonobese patients, although bias may have impacted these findings.

Preoperative prealbumin does not impact outcomes after left ventricular assist device implantation

“…When evaluating the interactions between obesity and prealbumin in our study, we found that patients had similar average distributions of prealbumin levels regardless of obesity status. Furthermore, our results support the findings of other studies that have noted the tendency of obese LVAD patients to have higher rates of postimplant adverse events 17 …”

“…Furthermore, our results support the findings of other studies that have noted the tendency of obese LVAD patients to have higher rates of postimplant adverse events. 17…”

Implications of obesity across the heart failure continuum

“… 76 Though the severely obese patients in this study had higher rates of complications, no differences were found in 30-day or 1-year survival, even after adjusting for age and clinical risk factors. Considering the findings of the meta-analysis by Khan et al 75 in which there was evidence of an obesity paradox in the short-term following LVAD implantation but not at 2 or 3 years, it would be interesting to see if the severely obese patients in this study would also lose their survival advantage at 2 or 3 years or even demonstrate increased mortality at longer-term follow-up.…”

“…The HeartWare ADVANCE trial ( n = 382) with 48 patients (13%) classified as severely obese found no difference in survival at 2 year follow-up, but had higher risk of driveline infection and acute renal dysfunction. 74 In a meta-analysis of 15 observational studies ( n = 26,842), Khan et al 75 found that obese patients who received an LVAD had significantly decreased all-cause mortality at both 6 months (RR = 0.79, p < 0.001) and one year (RR = 0.87, p = 0.008) compared with non-obese patients. However, there was no significant difference in all-cause mortality at 2 or 3 years, and obese patients had significantly higher risk of device-related infections, pump thrombosis and right sided HF compared to the non-obese.…”

Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist Device—Case Series and Review of Literature

“…So weight reduction should lead to less morbidity. There is no difference in terms of mortality between obese and non obese patients on LVAD (2,(16)(17)(18). There is still little experience with LSG in this specific patient population.…”