Extremes of body mass index do not impact mid-term survival after continuous-flow left ventricular assist device implantation

Brewer, Robert J.; Lanfear, David E.; Sai-Sudhakar, Chittoor; Sundareswaran, Kartik S.; Ravi, Y.; Farrar, David J.; Slaughter, Mark S.

doi:10.1016/j.healun.2011.11.006

Cited by 55 publications

(54 citation statements)

References 11 publications

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“…19,20 A large study using data from 896 HMII trial patients showed no difference in 2-year survival but increased rates of rehospitalizations in obese and extremely obese patients. 21 In the present study, we are the first to demonstrate that obesity is not associated with adverse survival even at 3 years after LVAD implantation.…”

Section: Discussionmentioning

confidence: 49%

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

Mohamedali

Yost

Bhat

2015

Journal of Cardiac Failure

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Section: Discussionmentioning

confidence: 49%

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

Mohamedali

Yost

Bhat

2015

Journal of Cardiac Failure

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Section: Responsesupporting

confidence: 46%

“…Our study found that obesity alone was not an independent risk factor for mortality in patients who underwent CF-LVAD implantation [1]. Other groups also have reported that obesity does not seem to be a risk factor for mortality in LVAD patients [2,3].We understand that much of the current data indicate that obesity increases mortality risk after cardiac surgery because of the co-factors that Gokalp et al mention in their letter [4,5]. However, as we discuss in our report, obesity should not be an absolute contraindication for long-term implantable LVAD therapy.…”

supporting

confidence: 46%

Effect of obesity on outcomes in patients who undergo implantation of a continuous-flow left ventricular assist device

et al. 2018

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ResponseWe thank Gokalp and colleagues for their thoughtful comments on our report. Our study found that obesity alone was not an independent risk factor for mortality in patients who underwent CF-LVAD implantation [1]. Other groups also have reported that obesity does not seem to be a risk factor for mortality in LVAD patients [2,3].We understand that much of the current data indicate that obesity increases mortality risk after cardiac surgery because of the co-factors that Gokalp et al. mention in their letter [4,5]. However, as we discuss in our report, obesity should not be an absolute contraindication for long-term implantable LVAD therapy.Our group of 120 obese patients (BMI > 30 kg/m 2 ) included a subset of 33 morbidly obese patients (BMI > 38.5 kg/m 2 ). In a Kaplan-Meier analysis ( Fig. 2 of our article) in which we compared the morbidly obese patients to all other patients (including those who were obese but not morbidly obese), we found significantly greater mortality in patients with morbid obesity (p = 0.049). In contrast, obesity of any degree (i.e., BMI > 30 kg/m 2 ) was not a significant independent predictor of postoperative mortality when all variables were placed in a multiple Cox proportion hazards model and subjected to stepwise regression analysis (hazard ratio = 0.98, 95% confidence interval 0.766-1.277, p = 0.13).At our center, we perform early extubation, discontinue the central line, and provide adequate nutritional support and aggressive occupational and physical therapy for obese patients to prevent complications such as pneumonia and infection [6]. This may be why our findings suggest that well-selected obese patients can receive a similar survival benefit from LVAD implantation as non-obese patients.

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“…Finally, AKI was positively associated with BMI in our cohort. Associations between BMI and renal complications and higher creatinine have been well documented [16, 17]. …”

Section: Discussionmentioning

confidence: 99%

“…This increased preoperative creatinine may be an indicator of baseline renal dysfunction of some degree, though various biomarkers and ratios (such as urine albumin and the urine albumin creatinine ratio) may prove more reliable [28, 29]. Although higher BMI has been associated with renal complications and AKI, it is conversely not associated with mortality (or may even be protective, in some cases, when compared to the underweight population) [3, 15-17]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

et al. 2019

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Background: Although acute kidney injury (AKI) is a common complication following cardiac surgery, less is known about the occurrence and consequences of moderate/severe AKI following left ventricular assist device (LVAD) implantation. Methods: All patients who had an LVAD implanted at our center from 2008 to 2016 were reviewed to determine the incidence of, and risk factors for, moderate/severe (stage 2/3) AKI and to compare postoperative complications and mortality rates between those with and those without moderate/severe AKI. Results: Of 246 patients, 68 (28%) developed moderate/severe AKI. A multivariable logistic regression comprising body mass index and prior sternotomy had fair predictive ability (area under the curve = 0.71). A 1-unit increase in body mass index increased the risk of moderate/severe AKI by 7% (odds ratio = 1.07; 95% confidence interval: 1.03–1.11); a prior sternotomy increased the risk more than 3-fold (odds ratio = 3.4; 95% confidence interval: 1.84–6.43). The group of patients with moderate/severe AKI had higher rates of respiratory failure and death than the group of patients with mild/no AKI. Patients with moderate/severe AKI were at 3.2 (95% confidence interval: 1.2–8.2) times the risk of 30-day mortality compared to those without. Even after adjusting for age and Interagency Registry for Mechanically Assisted Circulatory Support profile, those with moderate/severe AKI had 1.75 (95% confidence interval: 1.03–3.0) times the risk of 1-year mortality compared to those without. Discussion: Risk-stratifying patients prior to LVAD placement in regard to AKI development may be a step toward improving surgical outcomes.

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Extremes of body mass index do not impact mid-term survival after continuous-flow left ventricular assist device implantation

Cited by 55 publications

References 11 publications

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

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

Effect of obesity on outcomes in patients who undergo implantation of a continuous-flow left ventricular assist device

Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

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