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

Lee, Andy Y.; Tecson, Kristen M.; Lima, Brian; Shaikh, A.; Collier, Justin; Still, Sasha; Baxter, Ronald; DiMaio, J. Michael; Felius, Joost; Carey, Sandra; González-Stawinski, Gonzalo V.; Nauret, Richard; Wong, Marcus; Hall, Shelley; Joseph, Susan

doi:10.1111/aor.13380

Cited by 9 publications

(8 citation statements)

References 31 publications

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“…Another study including 30 severely obese patients with BMI ≥ 40 kg/m 2 who underwent LVAD implantation found higher rates of pump thrombosis and acute kidney injury in the severely obese group. 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.…”

Section: Left Ventricular Assist Devicementioning

confidence: 51%

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: 51%

Implications of obesity across the heart failure continuum

Elagizi

Carbone

Lavie

et al. 2020

Progress in Cardiovascular Diseases

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“…Multiple studies have evaluated the impact of obesity on post LVAD outcomes, and they found a higher morbidity burden in obese patients, including a higher incidence of pump thrombosis. 18 , 19 The presence of all these conditions is a likely reason for longer hospital stays and higher costs in the hypothyroid group.…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism Is Associated With Longer Hospital Stay Following Implantation Of Left Ventricular Assist Device

Isa

Buhari

Adeniran-Isa

et al. 2021

Clin Med Insights Cardiol

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Background: There has been a steady and consistent rise in the use of left ventricular assist devices in the management of patients with advanced heart failure. Hypothyroidism also remains one of the most common endocrine conditions with a significant impact on the development and overall outcomes of heart failure. The authors analyzed the National Inpatient Sample to evaluate the effect of hypothyroidism on the in-hospital outcomes of patients with end-stage heart failure following the placement of left ventricular assist device. Methods: The national inpatient sample was queried to identify all adult patients who had LVAD placement from 2004 to 2014. They were subsequently divided into those with hypothyroidism and those without hypothyroidism. The primary outcome was in-hospital mortality. Other outcomes were acute kidney injury, length, and cost of hospitalization. Logistic regression models were created to determine the outcomes of interest. Results: Of 2643 patients in the study, 5.4% had hypothyroidism, and 94.6% did not. The hypothyroid patients were significantly older compared to the non-hypothyroid patients (mean age 58.6 years vs 49.95 years, P-value <.0001). Both groups had similar gender composition. In-hospital mortality was similar across both groups. However, there was a higher incidence of acute kidney injury (AKI) in the hypothyroid group (adjusted odds ratio [aOR 1.83, P-value <.001]). Hypothyroid patients had longer hospital stays (adjusted mean difference [aMD] 5.19, P-value .0001). Hospital charges were also higher in the hypothyroid group. Conclusion: This study found that LVAD is associated with longer hospital stay in hypothyroid patients with heart failure.

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“…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.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2020

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For patients with advanced heart failure, left ventricular assist device (LVAD) can serve as a bridge to heart transplantation. Patients with class II obesity are eligible for implantation of LVAD, but do not meet criteria for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is proposed as weight losing modality in order to reach the NYHA criteria for listing. In our center, three patients on LVAD with need for weight reducing therapy were treated with laparoscopic sleeve gastrectomy. We reviewed our data retrospectively and compared it to the literature. Successful weight loss was achieved in all patients, without postoperative adverse events. Two out of three were listed on transplant waiting list. Our results are similar to those described in other series. BACKGROUNDLeft Ventricular Assist Device (LVAD) is a therapeutic option as bridge to orthotopic heart transplantation (OHT) in case of end stage cardiac failure. Obesity is associated with a poor outcome after OHT (1), for patients with severe obesity, it is recommended to achieve a BMI of less than 35 kg/m 2 before listing for OHT (1,2). Obesity is a worldwide expanding epidemic, in both developed and developing countries. (3,4) There is a strong association between obesity and heart failure: up to 35-43% of patients with heart failure are overweight or obese. (4-6) The Framingham heart study suggests that for every 1kg/m 2 increase in BMI the risk of developing heart failure increases by 5% in men and 7% in women. (7,8) In conclusion one can expect that more and more patients with obesity with end stage heart failure will not meet criteria for OHT due to obesity. Bariatric surgery may play a

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

Cited by 9 publications

References 31 publications

Implications of obesity across the heart failure continuum

Implications of obesity across the heart failure continuum

Hypothyroidism Is Associated With Longer Hospital Stay Following Implantation Of Left Ventricular Assist Device

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

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