Weight and LVAD Outcomes; Not Just a "Bridge to the Fridge?"

T. R. Ryan, A. N. Clark, S. J. Lehn, E. R. Lyden, M. Urban

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Obesity in LVAD recipients has been well documented. There is a lack of data on the predictive effect of baseline weight and weight gain after LVAD implantation on morbidity and mortality. The aim of our study was to evaluate if weight at LVAD implant and the change in weight during LVAD support could predict morbidity and/or mortality. METHODS: We reviewed the impact of baseline weight and weight gain on post-LVAD survival in patients who received a durable LVAD at our institution from January 1, 2014 until December 31, 2017. Patients who were supported for more than 12 months were divided into two groups: patients with baseline BMI < 30 (NW) and BMI > 30 (OW) and were evaluated for association of weight change with overall survival and freedom from LVAD related complications. RESULTS: Baseline characteristics of 189 patients are summarized in Table 1. One year survival was 74 ± 5% in patients with baseline BMI <30, and 77 ± 5% in patients with BMI >30. Baseline BMI was not associated with survival in multivariate Cox proportional hazard analysis (P = 0.91). Out of 89 patients who were still being supported 12 months after the LVAD implantation, 51 (57%) had BMI >30. Median weight gain in NW group at 12 months was 12(6,18)kg compared to 7(3,12)kg in OW group (P=0.02). There was no association of BMI at 12 months or weight change with overall post-LVAD survival, freedom from infection, pump malfunction, and neurological dysfunction. Freedom from right heart dysfunction at 12 months was 84 ± 5% in patients with BMI>30 compared to 97±3% in patients with BMI<30. For patients who crossed over from a baseline BMI<30 to BMI>30 at 12 months, weight gain emerged as a significant predictor of right heart failure (HR: 16.133 [95% CI; 1.806-145.026] p=0.013) CONCLUSION: Baseline, as well as 12 months post implantation BMI, had no impact on overall post-LVAD survival. Patients with NW at implant who crossed over to OW had no effect on survival, infection, pump complication or neurological dysfunction. However, this population had significantly less freedom from right heart failure.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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