320 - Obesity Does Not Impact 1 Year Survival After LVAD Implantation

Abstract

Purpose: The obesity paradox is well described in patients with heart failure. Among those who undergo heart transplantation, morbid obesity has been shown to adversely impact survival. We sought to determine the effect of obesity on survival after LVAD implantation. Methods: A single center retrospective review of all patients implanted with a LVAD between January, 2010 and September, 2015. Obesity was defined as BMI ≥ 30 kg/m2. The study population was stratified based on BMI. Results: 275 patients underwent LVAD implantation, of whom 108 (39%) were obese. Mean BMI was 34.8 ± 4.1 and 24.4 ± 3.1 kg/m2 in obese and non-obese groups, respectively. There was no significant difference in mean days on LVAD support (514.9 ± 470.7 obese vs 507.8 ± 465.4 non-obese, P = .9). Compared to non-obese patients, those in the obese group were younger (52.1 ± 11.4 vs 58.0 ± 13.7 years, P < .01), more likely to be African-American (73.1% vs 53.3%, P < .01), and have a non-ischemic etiology as the cause of heart failure (70.4% vs 56.9%, P = .02). They were also more likely to suffer from diabetes (51.9% vs 31.7%, P < .01) and OSA (26.9% vs 7.2%, P < .01). There were no significant differences between the 2 groups in the pre-op INTERMACS profiles, implant strategy at time of LVAD (BTT: 56.5% vs 48.5%, P = .2), type of LVAD (axial vs centrifugal), kidney/liver function. During the index hospitalization for LVAD implant, there were no significant differences between the 2 groups in the days on vasopressors (6.4 ± 6.4 vs 6.0 ± 6.7, P = .58) and on inotropic therapy (11.9 ± 9.3 vs 11.1 ± 11.9, P = .54). Importantly, the obese and non-obese groups had similar lengths of stay for index LVAD surgery (30.3 ± 21.7 vs 28.1 ± 20.4, P = .39) and similar rates of 30 day re-hospitalization (27% vs 26%, P = .84). Furthermore, the 1 year survival (Fig. 1) did not differ between the 2 groups (82.4% obese vs 75.5% non-obese, P = .21). Conclusion: In this single center experience, obesity does not appear to adversely impact length of stay, 30-day re-hospitalization, or 1 year survival after LVAD implantation. Whether more severe forms of obesity affect clinical outcomes deserve further study.