Outcomes of Severely Obese Patients Supported by a Centrifugal-Flow Left Ventricular Assist Device.

Abstract

BACKGROUND\nVentricular assist devices provide improved outcomes for advanced heart failure patients, but their benefit in the severely obese is not well documented.\n\n\nMETHODS\nPatients enrolled in the HeartWare ADVANCE trial (n=382) were divided into two body mass index (BMI) groups. Patients with severe obesity (> 35 kg/m2) were compared to a control group with BMI ≤ 35 kg/m2. The association of BMI with survival was tested using Kaplan-Meier analysis and major adverse events were compared.\n\n\nRESULTS\nAt implantation, 48 (13%) of patients were severely obese. There was no difference in survival through two years of support between severely obese patients and the control group. Severely obese patients were at higher risk of driveline infection (p=0.01) and acute renal dysfunction (p=0.002). Both groups experienced similar improvements in quality of life. Functional capacity improved in both severely obese and control patients, although severely obese patients had smaller improvements than controls in their six-minute walk scores.\n\n\nCONCLUSIONS\nDespite an increased risk of adverse events, severe obesity was not associated with reduced survival or quality of life. A better understanding of the risks and benefits of LVAD therapy in obese patients will help in the shared decision-making of the patient selection process.