The Impact of Obesity on Left Ventricular Assist Device Outcomes

Abstract

Background and Objectives: The understanding of high body mass index (BMI) and outcomes after Left Ventricular Assist Device (LVAD) implantation continues to evolve and the relationship has not been established yet. In this study, we investigated the effects of obesity (BMI > 30 kg/m2) on post–LVAD implantation outcomes. HeartWare LVAD and Heart Mate III LVAD were implanted. The primary outcome that was measured was mortality (in-hospital and on follow-up). The secondary outcomes that were measured were major adverse events. Materials and Methods: At our institution, the West German Heart and Vascular Center (Essen, Germany), from August 2010 to January 2020, a total of 210 patients received a long-term LVAD. Patients were stratified according to BMI ≥ 30 kg/m2 representing the obesity threshold. The first group (n = 162) had an average BMI of 24.2 kg/m2 (±2.9), and the second group (n = 48) had an average BMI of 33.9 kg/m2 (±3.2). Baseline demographics were analysed alongside comorbidities per group. Results: Overall mortality was not significantly different between the obese group (51.1% n = 24) and the nonobese group (55.2%, n = 85) (p = 0.619). The difference between the mean duration of survival of patients who expired after hospital discharge was insignificant (2.1 years ± 1.6, group 1; 2.6 years ± 1.5, group 2; p = 0.29). In-hospital mortality was unvaried between the two groups: group 1: n = 34 (44% out of overall group 1 deaths); group 2: n = 11 (45.8% out of overall group 2 deaths) (p > 0.05). Postoperative complications were unvaried between the obese and the non-obese group (all with p > 0.05). However, a significant difference was found with regards to follow-up neurological complications (18.5% vs. 37.8%, p = 0.01) and LVAD thrombosis (14.7% vs. 33.3%, p = 0.01), as both were higher in the obese population. Conclusion: Obesity does not form a barrier for LVAD implantation in terms of mortality (in-hospital and on follow up). However, a significantly higher incidence of follow-up LVAD thrombosis and neurological complications has been found in the obese group of patients.

Muscle strength, aerobic capacity, and exercise tolerance are impaired in left ventricular assist devices recipients: A pilot study

“…The high prevalence of obesity (over 30% of participants) in the sample should spark action towards weight management strategies in this population. Obesity is a known general risk factor for cardiovascular diseases, and has been found to increase the incidence of infections, neurological complications, and thrombosis in LVAD recipients, affecting short-term survival ( Zhigalov et al, 2020 ). The high percentage of participants under a psychotropic medication therapy is compatible with the psychological challenges faced by these persons in the transitional period following the LVAD implant ( Okam et al, 2020 ).…”

Isolated left ventricular assist device implantation produces variable changes to patient body mass index

“…Survival rates after LVAD surgery are a topic of controversy including evidence that morbidly obese patients suffer more complications. 15 There is also evidence demonstrating BMI at the time of surgery has no effect on mortality. 16 There is a phenomenon described as the "obesity paradox" where patients with heart failure tend to have better survival with moderate levels of obesity for uncertain reasons.…”

“…Although there did appear to be a trend for patients within the BMI group of 35–39.9 kg/m 2 for poorer survival, this change was not statistically significant. Survival rates after LVAD surgery are a topic of controversy including evidence that morbidly obese patients suffer more complications 15 . There is also evidence demonstrating BMI at the time of surgery has no effect on mortality 16 .…”

Artificial Muscles and Soft Robotic Devices for Treatment of End‐Stage Heart Failure

“…[18,19] Despite the continuous advances made in their technology, with third-generations using continuous-flow (non-pulsatile) contactless electromagnetic devices, these systems still present potentially serious complications. [20][21][22][23][24][25][26] Due to the contact formed between blood and the artificial surfaces, patients need lifelong anticoagulation treatment. [27][28][29] Most importantly, with an incidence of up to 20% of patients, [30,31] the risk of thrombosis (Figure 1a) eventually resulting in a stroke remains a serious complication for VAD recipients.…”