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

  • Original Article
  • Artificial Heart (Clinical)
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A Letter to the Editor to this article was published on 07 April 2018

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/m2, n = 18, 3.4%), normal-weight (18.5–25 kg/m2, n = 173, 32.9%), overweight (25–30 kg/m2, n = 182, 30.2%), and obese (> 30 kg/m2, 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.

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References

  1. Lietz K, Long JW, Kfoury AG, Slaughter MS, Silver MA, Milano CA, et al. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation. 2007;116:497–505.

    Article  PubMed  Google Scholar 

  2. Lund LH, Mancini D. Heart failure in women. Med Clin North Am. 2004;88:1321–45.

    Article  PubMed  Google Scholar 

  3. Taylor DO, Edwards LB, Boucek MM, Trulock EP, Aurora P, Christie J, et al. Registry of the international society for heart and lung transplantation: twenty-fourth official adult heart transplant report—2007. J Heart Lung Transpl. 2007;26:769–81.

    Article  Google Scholar 

  4. Miller LW, Lietz K. Candidate selection for long-term left ventricular assist device therapy for refractory heart failure. J Heart Lung Transpl. 2006;25:756–64.

    Article  Google Scholar 

  5. Clerkin KJ, Naka Y, Mancini DM, Colombo PC, Topkara VK. The impact of obesity on patients bridged to transplantation with continuous-flow left ventricular assist devices. JACC Heart Fail. 2016;4:761–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345:1435–43.

    Article  PubMed  CAS  Google Scholar 

  7. Warner-Stevenson L. The evolving role of mechanical circulatory support in advanced heart failure. In: Frazier OH, Kirklin JK, editors. Mechanical circulatory support. ISHLT monograph series, vol 1. New York: Elsevier; 2006. pp. 181–203.

    Google Scholar 

  8. Raymond AL, Kfoury AG, Bishop CJ, Davis ES, Goebel KM, Stoker S, et al. Obesity and left ventricular assist device driveline exit site infection. ASAIO J. 2010;56:57–60.

    Article  PubMed  Google Scholar 

  9. Frontera JA, Starling R, Cho SM, Nowacki AS, Uchino K, Hussain MS, Mountis M, Moazami N. Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices. J Heart Lung Transpl. 2017;36:673–83.

    Article  Google Scholar 

  10. Nassif ME, Tibrewala A, Raymer DS, Andruska A, Novak E, Vader JM, Itoh A, Silvestry SC, Ewald GA, LaRue SJ. Systolic blood pressure on discharge after left ventricular assist device insertion is associated with subsequent stroke. J Heart Lung Transpl. 2015;34:503–8.

    Article  Google Scholar 

  11. Han JJ, Sooppan R, Johnson AP, Chen CW, Gaffey AC, Phillips EC, Howard J, Rame JE, Acker MA, Atluri P. higher body mass index increases risk of HeartMate II pump Thrombosis but does not adversely affect long-term survival. Circ J. 2017;81:213–9.

    Article  PubMed  CAS  Google Scholar 

  12. Butler J, Howser R, Portner PM, Pierson RN. Body mass index and outcomes after left ventricular assist device placement. Ann Thorac Surg. 2005;79:66–73.

    Article  PubMed  Google Scholar 

  13. Go PH, Nemeh HW, Borgi J, Paone G, Morgan JA. Effect of body mass index on outcomes in left ventricular assit device recipients. J Card Surg. 2016;31:242–7.

    Article  PubMed  Google Scholar 

  14. Brewer JR, Lanfear DE, Sai-Sudhakar CB, Sundareswaran KS, Ravi Y, Farrar DJ, Slaughter MS. Extremes of body mass index do not impact mid-term survival after continuous-flow left ventricular assist device implantation. J Heart Lung Transpl. 2012;31:167–72.

    Article  Google Scholar 

  15. Mohamedali B, Yost G, Bhat G. Obesity as a risk factor for consideration for left ventricular assist devices. J Card Fail. 2015;21:800–5.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Drs. MacArthur A. Elayda and Suwei Wang of the Department of Biostatistics and Epidemiology at the Texas Heart Institute for their timely help in analyzing our large dataset. The Section of Scientific Publications at the Texas Heart Institute provided editorial support.

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Authors and Affiliations

  1. Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, TX, USA

    Nastasya Volkovicher, Chitaru Kurihara, Andre Critsinelis, Masashi Kawabori, Tadahisa Sugiura, Marcos Manon II, Andrew B. Civitello & Jeffrey A. Morgan

  2. Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Cooley 355N, 6770 Bertner Avenue, Houston, TX, 77030, USA

    Nastasya Volkovicher, Chitaru Kurihara, Andre Critsinelis, Masashi Kawabori, Tadahisa Sugiura, Marcos Manon II, Andrew B. Civitello & Jeffrey A. Morgan

  3. Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan

    Chitaru Kurihara

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  1. Nastasya Volkovicher
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  2. Chitaru Kurihara
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  3. Andre Critsinelis
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  4. Masashi Kawabori
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  5. Tadahisa Sugiura
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  6. Marcos Manon II
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  8. Jeffrey A. Morgan
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Correspondence to Chitaru Kurihara or Jeffrey A. Morgan.

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Volkovicher, N., Kurihara, C., Critsinelis, A. et al. Effect of obesity on outcomes in patients undergoing implantation of continuous-flow left ventricular assist devices. J Artif Organs 21, 180–187 (2018). https://doi.org/10.1007/s10047-017-1013-2

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  • DOI: https://doi.org/10.1007/s10047-017-1013-2

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