(42) - Long-Term Outcomes in Continous-Flow Left Ventricular Assist Device Patients with and without ICD

Abstract

Methods: Prospectively collected STS and INTERMACS data on all LVADs implanted at our institution from Dec 2008 to Jan 2014 was analyzed by dividing patients into two groups, BMI ≥ 35 and BMI < 35. Results: Of the 157 LVADs implanted during the study period, 121 (77%) were in patients with BMI < 35 and 36 (23%) were in patients with BMI ≥ 35. The BMI ≥ 35 group were younger (47 ± 12.7 yrs. vs. 55 ± 13.4 yrs.) and had more female patients (44% vs. 24%), all P values < 0.05. Preoperative morbidities, INTERMACS class, LVAD type and implantation designation were comparable between the two groups (Table). However, a prior history of myocardial infarction and arrhythmia were significantly higher in BMI < 35 group and right heart catheterization pressures were higher in BMI ≥ 35 group, P = < 0.05. Postoperative and device specific complications were higher in BMI ≥ 35 group, but only bleeding requiring reoperation (42% vs. 22% p = 0.03) and frequency of driveline infections were statistically significant (Table). Operative mortality was higher in BMI ≥ 35 group but was not statistically significant (19.5% vs. 11% p = 0.25). At a mean follow-up of 27.3 ± 20.5 months, fewer patients with a BMI ≥ 35 received a HTx (19% vs. 33% p = 0.15) and they had longer wait times (619 ± 372 vs.403 ± 342 days, p= 0.1). After HTx, patients with a BMI ≥ 35 had significantly higher post operative bleeding requiring reoperation (57% vs. 15% p= 0.03) and a longer hospital stay (45±43 days vs. 27 ± 21 days). HTx survival and graft survival was comparable in both groups. Conclusion: Morbidly obese patients requiring LVAD support encounter higher postoperative complications and wait longer for heart transplantation, however HTx and graft survival is comparable.