PREOPERATIVE MALNUTRITION IS ASSOCIATED WITH POOR CLINICAL OUTCOMES IN PATIENTS UNDERGOING LEFT VENTRICULAR ASSIST DEVICE (LVAD) IMPLANTATION

Abstract

PURPOSE: The presence of malnutrition and cachexia in patients with congestive heart failure (CHF) is well known. Few studies have examined nutritional status in patients while on LVAD support, however. We seek to evaluate this relationship and determine the effect nutritional parameters bear on clinical outcomes. METHODS: 99 patients with chronic (≤6 months) CHF received Heartmate LVADs over 7 years. Serum albumin, total protein (TP), absolute lymphocyte count (ALC), and body mass index (BMI) were obtained preoperatively and categorized as low or high: Albumin (≥3.5 or >3.S g/dL), TP (≥6.0 or >6.0 g/dL), ALC (≥0.85 or >0.85 × 103/ul), BMI (≥20 or >20 kg/m2). RESULTS: Patients with albumin ≥3.5 had lower bridge rates, higher 30-day post LVAD mortality, and longer ICU stays (66.7% vs. 84.1%, p = 0.041; 19.4% vs. 4.8%, p=0.020; 21.5+/−24.9 vs. 11.6+/−11.5 days, p = 0.009). Those with TP ≥6.0 had longer ICU stays (26.0+/−36.2 vs. 13.3+/−12.3 days, p=0.014). Patients with ALC ≥0.85 were older and had higher sepsis rates and lower 1-year post-transplant survival (55.7+/−8.1 vs. 48.4+/−12.8 years, p = 0.004; 24.2% vs. 9.1%, p = 0.044; 84.0% vs. 98.2%, p=0.013). BMI had no effect on clinical outcomes. CONCLUSIONS Low serum albumin, total protein, and ALC correlate with poor clinical outcomes in chronic CHF LVAD patients. Preoperative evaluation of these parameters might he utilized to identify at-risk patients. Future prospective clinical trials evaluating the efficacy of perioperative nutritional supplementation in this population are warranted.