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

Khan, Muhammad Shahzeb; Yuzefpolskaya, M.; Memon, Muhammad Mustafa; Usman, Muhammad; Yamani, Naser; Garan, A.R.; Demmer, Ryan T.; Colombo, P.C.

doi:10.1097/mat.0000000000001019

Cited by 27 publications

(15 citation statements)

References 35 publications

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“…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 …”

Section: Resultssupporting

confidence: 92%

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

et al. 2020

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Background: This single-center, the retrospective study evaluates the impact of preoperative serum prealbumin levels on outcomes after left ventricular assist device (LVAD) implantation.Methods: Adults undergoing LVAD implantation, with a recorded preoperative prealbumin level, between 2004 to 2018 were included. Primary outcomes included rates of 1-year survival and secondary outcomes included rates of postimplant adverse events. Threshold regression and restricted cubic splines were utilized to identify a cut-point to dichotomize prealbumin level. Prealbumin was also evaluated as a continuous variable. Multivariable logistic regression was used for risk-adjustment.Results: A total of 333 patients were included. Patients were dichotomized according to an optimal prealbumin threshold of 15 mg/dL: 47.4% (n = 158) had levels below and 52.6% (n = 175) had levels above this threshold, respectively. The rates of postimplant adverse events, including bleeding, infection, stroke, renal failure, and right heart failure, were similar between the groups (all P > .05). Furthermore, the rates of cardiac transplantation and device explantation were also similar (all P > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, and 1-year following LVAD implantation (all P > .05). In addition, lower prealbumin did not impact risk-adjusted 1-year mortality when modeled either as a categorical (OR, 1.08; 95% CI, 0.48-2.12; P = .82) or continuous variable (OR, 1.99; 95% CI, 0.73-2.34; P = .96). Conclusions:This study demonstrates that lower prealbumin levels were not predictive of increased post-LVAD morbidity or mortality. Although an established marker of nutritional and inflammatory status, the role of prealbumin in patient selection or prognostication appears limited in LVAD patients. K E Y W O R D S adverse events, left ventricular assist device, prealbumin, survival Yeahwa Hong and Laura Seese are co-first authors.

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Section: Resultssupporting

confidence: 92%

“…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…”

Section: Study Findings and Implicationsmentioning

confidence: 99%

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

et al. 2020

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“… 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: 89%

“…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.…”

Section: Left Ventricular Assist Devicementioning

confidence: 99%

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

Cited by 27 publications

References 35 publications

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

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

Implications of obesity across the heart failure continuum

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

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