(1044) - Implantation of Continuous Flow-Left Ventricular Assist Devices (CF-LVAD) in the Extremely Obese (BMI ≥40 kg/m2): A Single Center Experience

Abstract

Obesity is a risk factor for adverse cardiovascular events. A recent publication (Mohamedali et al) showed that patients with a BMI ≥30 kg/m2 who undergo CF-LVAD placement had no difference in survival when compared to patients with lower BMI. However, it is unknown if this applies to patients with extreme obesity. Here we describe a single center experience of patients that received a CF-LVAD that had extreme obesity defined as a BMI ≥40 Kg/m2 (WHO Class III obesity). Retrospective chart review of consecutive patients that received a CF-LVAD that had a BMI ≥40 at the day of implant from January 2009 to October 2014. Baseline demographics, length of stay and outcomes are reported. A total of 257 CF-LVADs were implanted during the study period. Of those, 19 patients (7%) had a BMI ≥40. The mean age was 48±10years, 74% were male, 53% African American, 68% had diabetes, 79% with non-ischemic cardiomyopathy as the cause of heart failure. The majority, 68%, received CF-LVAD as destination therapy with a median INTERMACS class of 3 (1-4). The mean BMI was 45±5 kg/m2. Average total length of stay was 33 ±15 days with 14±9 days of post-implant ICU stay. 30-day mortality was 26% (5 patients) and remained unchanged at 1 year. A total of 5 patients (26%) required RVAD support after implantation and of those patients only one survived to hospital discharge. The median number of readmissions was 2 (0-7), 4 patients (21%) had driveline infection-related readmissions, 4 (21%) had heart failure -related readmissions and 2 (11%) had cerebrovascular accidents. Our observations suggest that while CF-LVAD implantation is feasible in the extremely obese, the 30-day mortality and incidence of RV-failure are higher than those expected compared to the national average. These risks should be taken into consideration when implanting an LVAD in this select group of patients.