Obesity and outcomes after left ventricular assist device implantation-insights from the EUROMACS registry.
Eur J Cardiothorac Surg 2022;
62:6650624. [PMID:
35894678 DOI:
10.1093/ejcts/ezac401]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/07/2022] [Accepted: 07/25/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES
The objective was to analyze associations between obesity and outcomes after left ventricular assist device implantation.
METHODS
A retrospective analysis of the EUROMACS Registry was performed. Adult patients undergoing primary implantation of a continuous-flow left ventricular assist device between 2006 and 2019 were included (Medtronic HeartWare® HVAD®, Abbott HeartMate II®, Abbott HeartMate 3™). Patients were classified in 4 different groups according to body mass index at the time of surgery (body mass index < 20 kg/m2: n = 254; 20-24.9 kg/m2: n = 1281; 25-29.9 kg/m2: n = 1238; ≥ 30 kg/m2: n = 691).
RESULTS
The study cohort was comprised of 3464 patients. Multivariable Cox proportional cause-specific hazards regression analysis demonstrated that obesity (body mass index ≥ 30 kg/m2) was independently associated with significantly increased risk of mortality (body mass index "≥ 30" vs "20-24.9" kg/m2: hazard ratio 1.36, 95% confidence interval 1.18 to 1.57, overall p < 0.001). Moreover, obesity was associated with significantly increased risk of infection and driveline infection. The probability to undergo heart transplantation was significantly decreased in obese patients (body mass index "≥ 30" vs "20-24.9" kg/m2: hazard ratio 0.59, 95% confidence interval 0.48 to 0.74, overall p < 0.001).
CONCLUSIONS
Obesity at the time of left ventricular assist device implantation is associated with significantly higher mortality and increased risk of infection as well as driveline infection. The probability to undergo heart transplantation is significantly decreased. These aspects should be considered when devising a treatment strategy before surgery.
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