Outcomes in patients with advanced heart failure and small body size undergoing continuous-flow left ventricular assist device implantation

Abstract

Left ventricular assist devices (LVADs) have become a preferred treatment option for patients with end-stage heart failure when used as a bridge to transplant or as a destination therapy. However, the association between small body size and postoperative outcomes for continuous-flow (CF) LVAD recipients is still being studied. We sought to determine whether body surface area (BSA) is associated with patient outcomes after CF-LVAD implantation. The study cohort of our single-center, retrospective review consisted of all patients (n = 526) who underwent CF-LVAD implantation (n = 403 HeartMate II, n = 123 HeartWare) between November 2003 and March 2016 regardless of indication. Patients were stratified into 2 cohorts according to their BSA measurements: small BSA (<1.5 m, n = 13) and non-small BSA (≥1.5 m, n = 513). We compared the survival of the small-BSA cohort with that of the non-small-BSA cohort. Patients with a small BSA had lower survival rates at 1, 6, 12, and 24 months (76.9, 61.5, 53.8, and 38.5%, respectively) than did patients with a non-small BSA (90.4, 80.9, 74.7, and 67.6% respectively; overall, p = 0.004). Cox proportional hazard analysis showed that a small BSA was an independent predictor of postoperative mortality (hazard ratio = 0.22, 95% confidence interval = 0.05-0.97, p < 0.04). These findings highlight the adverse impact of a small BSA on outcomes after CF-LVAD implantation.

Propensity score‐based analysis of long‐term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

“…Smaller patients more often receive an HVAD, because of its smaller size. A retrospective study showed that a small BSA is an independent predictor for mortality after LVAD implantation 14 . Within the UMCU, HM3 is implanted since December 2015, whereas the first HVAD was implanted in November 2010.…”

“…A retrospective study showed that a small BSA is an independent predictor for mortality after LVAD implantation. 14 Within the UMCU, HM3 is implanted since December 2015, whereas the first HVAD was implanted in November 2010. Because of the growing experience over the years, it is likely that treatment of complications continuously improves over the years.…”