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

Yost, Gardner; Coyle, Laura; Gallagher, Colleen; Graney, N.; Siemeck, Roxanne; Tatooles, Antone; Pappas, Patroklos; Bhat, Geetha

doi:10.21037/jtd.2017.10.52

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…4 Recent studies have suggested that increased BMI does not have an impact on LVAD implantation outcomes. 5 Our findings are like those reported by previous authors, as BMI did not show any association with mortality.…”

Section: Discussionsupporting

confidence: 92%

Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy

Okoh

Chan

Schultheis

et al. 2019

Innovations�(Phila)

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Objective We sought to investigate outcomes after left ventricular assist device (LVAD) implantation in advanced heart failure patients stratified by race. Methods Patients who had LVADs inserted at a single center as a bridge to transplant (BTT) or destination therapy (DT) were divided into 3 groups based on race: Caucasian, African American (AA), and Hispanic. Postoperative outcomes including complications, discharge disposition, and survival at defined time points were compared. Cox proportional hazards were used to identify factors associated with 1-year all-cause survival. Results A total of 158 patients who had LVADs as BTT ( n = 63) and DT ( n = 95) were studied. Of these, 56% ( n = 89) were Caucasians, 35% ( n = 55) were AA, and 9% ( n = 14) were Hispanics. AA patients had higher BMI and lower socioeconomic status and educational level, and were more likely to be single or divorced. Operative outcomes were similar among all 3 groups. Unadjusted 30-day, 6-month, 1-year, and 2-year survival rates for Caucasians versus AA versus Hispanics were 82% versus 89% versus 93%, P = 0.339; 74% versus 80% versus 71%, P = 0.596; 67% versus 76% versus 71%, P = 0.511; and 56% versus 62% versus 68%, P = 0.797. On multivariate analysis, device-related infection, malfunction, and abnormal rhythm were factors associated with overall all-cause mortality. Conclusion AA patients who undergo LVAD implantation as BTT or DT have lower socioeconomic status and educational level compared to their Caucasian or Hispanic counterparts. These differences, however, do not translate into postimplant survival outcomes.

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Section: Discussionsupporting

confidence: 92%

Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy

Okoh

Chan

Schultheis

et al. 2019

Innovations�(Phila)

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“…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.…”

Section: Discussionsupporting

confidence: 90%

“…Obesity has been shown to increase morbidity, mortality, and overall system costs in certain types of general cardiac surgery ; however, published outcomes of obese patients following LVAD implantation are limited. Although the risks of complications related to obesity, such as thromboembolic events , device infection , and RV failure have been reported, these studies suggest conflicting conclusions in regards to the effect of obesity on mortality. The development of more durable LVAD technologies has improved overall survival and complication rates, even as the cases accepted for surgery have become more complicated .…”

Section: Introductionmentioning

confidence: 99%

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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“…A further study by Mohamedali et al conducted on 288 HMII and HVAD patients found that despite higher readmission rates, obesity was not associated with a decrease in survival rates at three years post LVAD implantation [ 25 ]. Greater insight was provided by Yost et al, who in their analysis also included a group of extremely obese (BMI > 35 kg/m 2 ) patients receiving HMII and HVAD LVADs [ 26 ]. On assessment of 30-day, 1-, and 2- years follow neither the obese nor the extremely obese showed any significant difference in survival ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…On assessment of 30-day, 1-, and 2- years follow neither the obese nor the extremely obese showed any significant difference in survival ( Table 4 ). Postoperative adverse events and complications including length of stay, sternal infection, driveline/pocket infection, systemic infection, GI-bleeding, and neurological events were also found to be unvaried across groups in the study [ 26 ]. Nevertheless, studies in the past have found severely obese (BMI ≥ 35 kg/m 2 ) patients to have worse outcomes on LVAD.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Obesity on Left Ventricular Assist Device Outcomes

et al. 2020

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Background and Objectives: The understanding of high body mass index (BMI) and outcomes after Left Ventricular Assist Device (LVAD) implantation continues to evolve and the relationship has not been established yet. In this study, we investigated the effects of obesity (BMI > 30 kg/m2) on post–LVAD implantation outcomes. HeartWare LVAD and Heart Mate III LVAD were implanted. The primary outcome that was measured was mortality (in-hospital and on follow-up). The secondary outcomes that were measured were major adverse events. Materials and Methods: At our institution, the West German Heart and Vascular Center (Essen, Germany), from August 2010 to January 2020, a total of 210 patients received a long-term LVAD. Patients were stratified according to BMI ≥ 30 kg/m2 representing the obesity threshold. The first group (n = 162) had an average BMI of 24.2 kg/m2 (±2.9), and the second group (n = 48) had an average BMI of 33.9 kg/m2 (±3.2). Baseline demographics were analysed alongside comorbidities per group. Results: Overall mortality was not significantly different between the obese group (51.1% n = 24) and the nonobese group (55.2%, n = 85) (p = 0.619). The difference between the mean duration of survival of patients who expired after hospital discharge was insignificant (2.1 years ± 1.6, group 1; 2.6 years ± 1.5, group 2; p = 0.29). In-hospital mortality was unvaried between the two groups: group 1: n = 34 (44% out of overall group 1 deaths); group 2: n = 11 (45.8% out of overall group 2 deaths) (p > 0.05). Postoperative complications were unvaried between the obese and the non-obese group (all with p > 0.05). However, a significant difference was found with regards to follow-up neurological complications (18.5% vs. 37.8%, p = 0.01) and LVAD thrombosis (14.7% vs. 33.3%, p = 0.01), as both were higher in the obese population. Conclusion: Obesity does not form a barrier for LVAD implantation in terms of mortality (in-hospital and on follow up). However, a significantly higher incidence of follow-up LVAD thrombosis and neurological complications has been found in the obese group of patients.

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

Cited by 16 publications

References 20 publications

Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy

Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy

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

The Impact of Obesity on Left Ventricular Assist Device Outcomes

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