Author + information
- Received March 8, 2016
- Revision received May 9, 2016
- Accepted May 26, 2016
- Published online October 1, 2016.
- Kevin J. Clerkin, MDa,
- Yoshifumi Naka, MD, PhDb,
- Donna M. Mancini, MDc,
- Paolo C. Colombo, MDa and
- Veli K. Topkara, MD, MSca,∗ ()
- aDivision of Cardiology, Department of Medicine, Columbia University Medical Center–New York Presbyterian Hospital, New York, New York
- bDivision of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center–New York Presbyterian, New York, New York
- cDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Veli K. Topkara, Center for Advanced Cardiac Care, Columbia University Medical Center–New York Presbyterian Hospital, 622 West 168th Street, PH9-977, New York, New York 10032.
Objectives This study sought to determine if obese patients had worse post–left ventricular assist device (LVAD) implantation outcomes and if the implantation of an LVAD allowed for weight loss.
Background Obesity is a risk factor for cardiovascular disease including heart failure. Obese heart failure patients have better outcomes than those with normal weight; however, obese patients have worse outcomes after heart transplantation.
Methods Patients were identified in the United Network for Organ Sharing (UNOS) database that underwent LVAD implantation as bridge to transplantation from May 2004 and April 2014, with follow-up through June 2014. Patients were grouped according to body mass index (BMI) based on the World Health Organization classification.
Results Among 3,856 patients, the risk of death or delisting was not significantly different between BMI groups (p = 0.347). There was no increased risk of death (p = 0.234) or delisting (p = 0.918). The risk of complication requiring UNOS status upgrade was increased for those with class II obesity or greater (hazard ratio: 1.48; p = 0.004), driven by increased infection and thromboembolism. Obese patients had worse post-transplantation outcomes. Weight loss substantial enough to decrease BMI group was achieved by a small proportion of patients listed with class I obesity or greater (9.6% to 15.5%).
Conclusions Patients with obesity had similar freedom from death or delisting while on LVAD support. However, class II obese or greater patients had an increased risk of complications requiring UNOS status upgrade compared with those with normal BMI during LVAD support and decreased post-transplantation survival. Weight loss on device therapy was possible, but uncommon. Careful consideration is needed when a bridge to weight loss strategy is proposed.
This study was supported by Lisa and Mark Schwartz and the Program to Reverse Heart Failure at New York Presbyterian Hospital/Columbia University. Dr. Clerkin is supported by National Institutes of Health Grant T32 HL007854-16. Dr. Naka received consulting fees from Thoratec and St. Jude Medical. Dr. Columbo has received a research grant from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 8, 2016.
- Revision received May 9, 2016.
- Accepted May 26, 2016.
- 2016 American College of Cardiology Foundation