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Effects of Body Mass Index on Survival, Length of Stay, Infection, and Strokes After Left Ventricular Assist Device Implantation
Abstracts S433 Methods: Patients with dLVADs implanted from March 2011 to June 2016 were retrospectively analyzed. Patients with tMCS prior to dLVAD implantation were defined as those who received an intra-aortic balloon pump, TandemHeart, and/or extracorporeal membrane oxygenation prior to dLVAD. Hospitalization costs of implant admission, length of stay, INTERMACS profiles, and survival were compared between patients with and without tMCS prior to dLVAD. One-year survival after dLVAD implantation in patients with and without prior tMCS prior to dLVAD was evaluated using Cox proportional hazards regression. Results: Among 128 dLVAD patients (age 57.0 ± 12.2 years, 24.2% female), 38 patients (29.7%) had tMCS prior to dLVAD placement. Hospitalization costs were significantly higher in patients with tMCS prior to dLVAD versus those without tMCS prior to dLVAD (median $237,703 versus $188,798; P = 0.002, Figure). The increased hospital costs in tMCS patients were associated with a trend for a longer LOS (P = 0.09). The INTERMACS profiles in patients with tMCS prior to dLVAD were more severe, as well, compared with patients without tMCS prior to dLVAD (mean 2.05 ± 0.73 versus 3.01 ± 0.73; P< 0.0001). 37 (28.9%) dLVAD patients died during the first year after dLVAD, and there was a trend for increased 1-year mortality in patients with temporary MCS prior to dLVAD (HR 1.92, 95% CI 0.91-4.06; P = 0.09). Conclusion: Hospital costs were significantly higher and INTERMACS profiles were more severe in patients with temporary MCS prior to durable LVAD placement versus those without temporary MCS prior to durable LVAD; however, one-year survival was not significantly different between the two groups.
treated with LVAD as BTT in an Italian vs US hospital with comparable characteristics. Methods: We evaluated a total of 125 consecutive BTT LVAD patients listed for heart transplantation (HTx) at an Italian hospital in Milan (N= 68) vs those listed for HTx in an US hospital in San Diego (N= 57). Demographic and outcomes were compared between the two centers. Results: US patients were significant older at LVAD implantation than Italian patients (59 vs. 54 years, p= 0.003). In the US center among 57 LVAD patients on HTx waiting list, 42 patients (74%) underwent HTx after a median time of 215 days (258-838 days). In the Italian center 35 out of 68 listed LVAD patients (51%) were transplanted after a median time of 426 days (258-838 days, p= 0.0002). The median age of US donors was almost half the age of Italian donors (20 vs 39 years old, p< 0.0001). Eight Italian patients (22.9%) died after HTx vs 5 US patients (11.9%, p= 0.23). In the Italian group post-HTx survival at 1, 2, 3, and 5 years was respectively 87%, 78%, 65%, and 60% vs 85%, 79%, 79%, and 73% in the US group (Log-rank test p= 0.26). Among those patients with at least 1 year of follow up in the US group (n= 46), 3(7%) patients were still on support, 35(76%) were alive after HTx and 8(17%) were died. In the Italian group (n= 61 with at least 1 year of follow up), 50(82%) patients were still on support, 5(8%) were alive after HTx and 6(10%) were died. There was a significant difference in the number of patients still on support after 1 year (p< 0.0001). Conclusion: Most of US patients were transplanted after 1 year from LVAD implantation as BTT, whereas < 1 0% of Italian patients received HTx. Although in Italy time on waiting list and donor age markedly differ, survival remained identically at least at 2 years of follow up and not significantly decreased after 2 years. Different needs and complications must be expected from patients on list for longer time on LVAD support comparing with patients with shorter time on supports as US patients.
1( 329) Effects of Body Mass Index on Survival, Length of Stay, Infection, and Strokes After Left Ventricular Assist Device Implantation A. Phancao , D. Horstmanshof, S. Jones, N. Chelikani, M. El Banayosy, K. Nelson, J. Long. Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK.
1( 326) WITHDRAWN
1( 327) WITHDRAWN 1( 328) Comparison Between Italian and Unites States Centers on Outcome and Likelihood of Heart Transplantation in Patients Treated with Left Ventricular Assist Device as Bridge to Transplantation E. Ammirati ,1 M. Brambatti,2 M. Cipriani,1 E. Perna,1 A. Mizeracki,2 J. Silva Enciso,2 H. Tran,2 A.R. Calini,1 G.V. Pretorius,3 C.F. Russo,1 M. Frigerio,1 E. Adler.2 1De Gasperis CardioCenter, Niguarda Hospital, Milan, Italy; 2Cardiology, University of California San Diego, La Jolla, CA; 3Cardiothoracic Surgery, University of California San Diego, La Jolla, CA. Purpose: In Italy compared to United States (US) donors are older and their availability is reduced. These factors could affect the final outcome of patients with advanced heart failure treated with left ventricular assist device (LVAD) as bridge to transplantation (BTT). We compared the outcome of patients
Purpose: There is limited data published regarding the effects of weight and obesity on outcomes of patients with left ventricular assist devices (LVAD). We evaluated the association between body mass index (BMI) on outcomes in patients after LVAD implantation. Methods: We retrospectively reviewed all charts from patients at our institution who underwent HeartMate II LVAD implantation from 2008 to 9/2016. Patients were divided into 5 groups based on immediate preimplantation BMI; group 1 underweight (BMI< 18.5 kg/m2), group 2 normal (18.5-24.9 kg/m2), group 3 overweight (BMI 25-29.9 kg/m2), group 4 class I obesity (BMI 30-34.9 kg/m2), group 5 class II obesity (BMI 35-39.9 kg/m 2), and group 6 class III obesity (BMI> 40 kg/m2). Differences between BMI groups and outcomes of survival, strokes (CVA), implantation length of stay (LOS), and LVAD-related infections were tested using Kaplan-Meier analysis and Kendall tau-b correlations. Log Rank Mantel Cox analysis was used to determine p values. Oneway ANOVA was used to determine within group and between group associations. Results: A total of 294 patients who underwent HeartMate II LVAD implantation between 2008 and 9/2016 were included. Patients with bariatric surgery were excluded. If patients had LVAD exchanges, only data from their initial implantation were included. ANOVA analysis for between group correlations did not demonstrate a difference among BMI group and any of the variables of interest. Conclusion: There was no statistically significant difference in CVA, LVADrelated infections, or 4-year survival between BMI groups. There were trends of increased infections in the highest two BMI groups, although this was not statistically significant. Further investigation of the relationship between weight and LVAD outcomes are needed.
S434
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 1( 331)
BMI Group (BMI range kg/m2)
N (% from total patients)
1 (< 18.5) 2 (18.5-< 24.9) 3 (25-< 29.9) 4 (30-< 34.9) 5 (35-< 39.9) 6 (> 40) Log Rank (Mantel-Cox) One-way ANOVA Between Group correlation
8 (2.7%) 65 (22.1%) 112 (38.1%) 65 (22.1%) 31 (10%) 13 (4.4%)
Percent Patients Free from Infection at 2-years
Percent Patients Free from stroke 4-year at 2-years survival
Median Implant Hospital LOS (days)
Mean Implant Hospital LOS Days (±SD)
58.3% 68.5% 60.9% 56.1% 54.7% 51.3% p= 0.51
58.3% 74.3% 75.9% 87.7% 55.8% 72.9% p= 0.15
31.3% 53.9% 41.6% 48.1% 33.4% 49.2% p= 0.82
38 21 25 25 22 31
32 (± 10) 29 (± 22) 30 (± 22) 29 (± 17) 28 (± 16) 32 (± 20)
p= 0.72
p= 0.36
p= 0.93
p= 0.98
1( 330) Effective Mechanical Circulatory Support with Impella in Postcardiotomy Cardiogenic Shock D.G. Tang ,1 G.W. Vetrovec,2 C. Toma,3 A.B. Civitello,4 M. Silver,5 M.B. Anderson.6 1Virginia Commonwealth University, Richmond, VA; 2Cardiology, Virginia Commonwealth University, Richmond, VA; 3Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Baylor St. Luke's Medical Center / Texas Heart Institute, Houston, TX; 5Genesys Regional Medical Center, Grand Blanc, MI; 6Cardiothoracic Surgery, Einstein Medical Center, Philadelphia, PA. Purpose: This report describes the hospital and 30 day outcomes for postcardiotomy cardiogenic shock (PCCS) patients (pts) requiring mechanical circulatory support (MCS) with temporary ventricular assist devices - Impella 2.5, CP, 5.0/LD. Methods: All pts in the cVAD registry from 2008-2015 who underwent openheart surgery (OHS) and required hemodynamic support for PCCS provided by Impella devices inserted within the first 48 hours post-OHS were analyzed. The cVAD Registry is a multi-center (59 sites), retrospective database for consecutive, Impella supported pts. Results: The cohort included 77 pts: Impella 2.5-19 pts, CP-14 pts, 5.0/LD-44 pts. Mean age for all patients was 64.6+11 (SD). CABG was the only surgery performed in 45% of pts; 55% had CABG plus valve or valve surgery alone. The 2.5 and CP devices were implanted more frequently < 6 hrs after shock onset (2.5 - 83%, CP - 71%) while the 5.0 was implanted > 24 hrs after shock onset in 52% of pts. Overall, 79% of pts were successfully supported and 65% successfully weaned. Total complications were not different between devices with overall CVA 3.9%, acute renal failure 34%, bleeding requiring surgery 23% and hemolysis 5%. Survival to discharge and 30 days was 58%. There was no significant difference in outcome by extent of device support used. More unstable pts tended to receive higher level support devices (CP, 5.0/LD). It is likely that higher level support devices are effective in more compromised pts. Probability of survival was significantly predicted from highest to lowest survival based on the following indications in order of support indication: Low cardiac output syndrome, Cardiogenic Shock and Failure to Wean (Figure). Conclusion: In this cVAD Registry analysis, Impella support provides competitive outcomes compared to prior MCS data with a suggestion that higher support devices are important for the most severe hemodynamic compromise. Further studies will be important to identify appropriate device choice.
Effect of Pre-Durable Mechanical Circulatory Support Device Anemia on Post-Device Implant Mortality S. Zalawadiya , J. Lindenfeld, K. Schlendorf, M. Danter, M. Djunaidi, M. Wigger, A. Shah, H. Ooi, S. Brown-Sacks, N. Haglund, M. Brinkley, M. Keebler. Vanderbilt University Medical Center, Nashville, TN. Purpose: Limited data exist evaluating the impact of anemia pre-durable mechanical circulatory support devices (MCSDs) on post-MCSD survival. Methods: We performed post-hoc analysis of 302 patients undergoing durable MCSD implantation between April 2009 and august 2016 in this single center study. Pre-MCSD hemoglobin (Hgb) was analyzed as both continuous and categorical variables. Pre-MCSD anemia was defined as blood hemoglobin (Hgb) level < 13 g/dL for male and < 12 g/dL for female. KaplanMeier survival estimates were compared using log-rank test for those with and without anemia. Cox-proportional hazard analyses were performed to assess relationship between anemia and post-MCSD mortality. Results: Anemia was highly prevalent at baseline (69.9%). Those with anemia were more likely to have lower body mass index (kg/m2; 28.8±5.6 versus (vs) 30.4±6.0), ischemic heart failure (52.1% vs 37.4%) and on intra-aortic balloon pump (22.3% vs 12.1%) at the time of MCSD implantation (p< 0.05 for all). Total of 83 deaths were observed over median follow up of 1 year. In the adjusted analysis, those with anemia were at significantly higher risk of post-MCSD mortality (see table 1 and figure 1) Conclusion: Pre-MCSD anemia was identified as significant risk marker for post-MCSD mortality. Future studies are required to assess impact of interventions aimed at correcting anemia and their relationship with post-MCSD mortality.
1( 332) Increasing Severity of Periprocedural Right Heart Failure Leads to Incrementally Worse Outcomes Following Left Ventricular Assist Device Implantation B. Lima ,1 A. Shaikh,1 K.M. Tecson,2 S. Still,1 J. Collier,1 R.D. Baxter,1 J. Felius,1 S.A. Hall,1 G.V. Gonzalez-Stawinski,1 S.M. Joseph.1 1Baylor University Medical Center, Dallas, TX; 2Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX. Purpose: Right heart failure (RHF) is a known risk factor for poor outcomes following left ventricular assist device (LVAD) implantation. While numerous predictive models of RHF have been proposed, stratification of outcomes based on RHF severity have not been studied. We examined the impact of increasing severity of postoperative RHF and associated risk factors.
treated with LVAD as BTT in an Italian vs US hospital with comparable characteristics. Methods: We evaluated a total of 125 consecutive BTT LVAD patients listed for heart transplantation (HTx) at an Italian hospital in Milan (N= 68) vs those listed for HTx in an US hospital in San Diego (N= 57). Demographic and outcomes were compared between the two centers. Results: US patients were significant older at LVAD implantation than Italian patients (59 vs. 54 years, p= 0.003). In the US center among 57 LVAD patients on HTx waiting list, 42 patients (74%) underwent HTx after a median time of 215 days (258-838 days). In the Italian center 35 out of 68 listed LVAD patients (51%) were transplanted after a median time of 426 days (258-838 days, p= 0.0002). The median age of US donors was almost half the age of Italian donors (20 vs 39 years old, p< 0.0001). Eight Italian patients (22.9%) died after HTx vs 5 US patients (11.9%, p= 0.23). In the Italian group post-HTx survival at 1, 2, 3, and 5 years was respectively 87%, 78%, 65%, and 60% vs 85%, 79%, 79%, and 73% in the US group (Log-rank test p= 0.26). Among those patients with at least 1 year of follow up in the US group (n= 46), 3(7%) patients were still on support, 35(76%) were alive after HTx and 8(17%) were died. In the Italian group (n= 61 with at least 1 year of follow up), 50(82%) patients were still on support, 5(8%) were alive after HTx and 6(10%) were died. There was a significant difference in the number of patients still on support after 1 year (p< 0.0001). Conclusion: Most of US patients were transplanted after 1 year from LVAD implantation as BTT, whereas < 1 0% of Italian patients received HTx. Although in Italy time on waiting list and donor age markedly differ, survival remained identically at least at 2 years of follow up and not significantly decreased after 2 years. Different needs and complications must be expected from patients on list for longer time on LVAD support comparing with patients with shorter time on supports as US patients.
1( 329) Effects of Body Mass Index on Survival, Length of Stay, Infection, and Strokes After Left Ventricular Assist Device Implantation A. Phancao , D. Horstmanshof, S. Jones, N. Chelikani, M. El Banayosy, K. Nelson, J. Long. Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK.
1( 326) WITHDRAWN
1( 327) WITHDRAWN 1( 328) Comparison Between Italian and Unites States Centers on Outcome and Likelihood of Heart Transplantation in Patients Treated with Left Ventricular Assist Device as Bridge to Transplantation E. Ammirati ,1 M. Brambatti,2 M. Cipriani,1 E. Perna,1 A. Mizeracki,2 J. Silva Enciso,2 H. Tran,2 A.R. Calini,1 G.V. Pretorius,3 C.F. Russo,1 M. Frigerio,1 E. Adler.2 1De Gasperis CardioCenter, Niguarda Hospital, Milan, Italy; 2Cardiology, University of California San Diego, La Jolla, CA; 3Cardiothoracic Surgery, University of California San Diego, La Jolla, CA. Purpose: In Italy compared to United States (US) donors are older and their availability is reduced. These factors could affect the final outcome of patients with advanced heart failure treated with left ventricular assist device (LVAD) as bridge to transplantation (BTT). We compared the outcome of patients
Purpose: There is limited data published regarding the effects of weight and obesity on outcomes of patients with left ventricular assist devices (LVAD). We evaluated the association between body mass index (BMI) on outcomes in patients after LVAD implantation. Methods: We retrospectively reviewed all charts from patients at our institution who underwent HeartMate II LVAD implantation from 2008 to 9/2016. Patients were divided into 5 groups based on immediate preimplantation BMI; group 1 underweight (BMI< 18.5 kg/m2), group 2 normal (18.5-24.9 kg/m2), group 3 overweight (BMI 25-29.9 kg/m2), group 4 class I obesity (BMI 30-34.9 kg/m2), group 5 class II obesity (BMI 35-39.9 kg/m 2), and group 6 class III obesity (BMI> 40 kg/m2). Differences between BMI groups and outcomes of survival, strokes (CVA), implantation length of stay (LOS), and LVAD-related infections were tested using Kaplan-Meier analysis and Kendall tau-b correlations. Log Rank Mantel Cox analysis was used to determine p values. Oneway ANOVA was used to determine within group and between group associations. Results: A total of 294 patients who underwent HeartMate II LVAD implantation between 2008 and 9/2016 were included. Patients with bariatric surgery were excluded. If patients had LVAD exchanges, only data from their initial implantation were included. ANOVA analysis for between group correlations did not demonstrate a difference among BMI group and any of the variables of interest. Conclusion: There was no statistically significant difference in CVA, LVADrelated infections, or 4-year survival between BMI groups. There were trends of increased infections in the highest two BMI groups, although this was not statistically significant. Further investigation of the relationship between weight and LVAD outcomes are needed.
S434
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 1( 331)
BMI Group (BMI range kg/m2)
N (% from total patients)
1 (< 18.5) 2 (18.5-< 24.9) 3 (25-< 29.9) 4 (30-< 34.9) 5 (35-< 39.9) 6 (> 40) Log Rank (Mantel-Cox) One-way ANOVA Between Group correlation
8 (2.7%) 65 (22.1%) 112 (38.1%) 65 (22.1%) 31 (10%) 13 (4.4%)
Percent Patients Free from Infection at 2-years
Percent Patients Free from stroke 4-year at 2-years survival
Median Implant Hospital LOS (days)
Mean Implant Hospital LOS Days (±SD)
58.3% 68.5% 60.9% 56.1% 54.7% 51.3% p= 0.51
58.3% 74.3% 75.9% 87.7% 55.8% 72.9% p= 0.15
31.3% 53.9% 41.6% 48.1% 33.4% 49.2% p= 0.82
38 21 25 25 22 31
32 (± 10) 29 (± 22) 30 (± 22) 29 (± 17) 28 (± 16) 32 (± 20)
p= 0.72
p= 0.36
p= 0.93
p= 0.98
1( 330) Effective Mechanical Circulatory Support with Impella in Postcardiotomy Cardiogenic Shock D.G. Tang ,1 G.W. Vetrovec,2 C. Toma,3 A.B. Civitello,4 M. Silver,5 M.B. Anderson.6 1Virginia Commonwealth University, Richmond, VA; 2Cardiology, Virginia Commonwealth University, Richmond, VA; 3Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Baylor St. Luke's Medical Center / Texas Heart Institute, Houston, TX; 5Genesys Regional Medical Center, Grand Blanc, MI; 6Cardiothoracic Surgery, Einstein Medical Center, Philadelphia, PA. Purpose: This report describes the hospital and 30 day outcomes for postcardiotomy cardiogenic shock (PCCS) patients (pts) requiring mechanical circulatory support (MCS) with temporary ventricular assist devices - Impella 2.5, CP, 5.0/LD. Methods: All pts in the cVAD registry from 2008-2015 who underwent openheart surgery (OHS) and required hemodynamic support for PCCS provided by Impella devices inserted within the first 48 hours post-OHS were analyzed. The cVAD Registry is a multi-center (59 sites), retrospective database for consecutive, Impella supported pts. Results: The cohort included 77 pts: Impella 2.5-19 pts, CP-14 pts, 5.0/LD-44 pts. Mean age for all patients was 64.6+11 (SD). CABG was the only surgery performed in 45% of pts; 55% had CABG plus valve or valve surgery alone. The 2.5 and CP devices were implanted more frequently < 6 hrs after shock onset (2.5 - 83%, CP - 71%) while the 5.0 was implanted > 24 hrs after shock onset in 52% of pts. Overall, 79% of pts were successfully supported and 65% successfully weaned. Total complications were not different between devices with overall CVA 3.9%, acute renal failure 34%, bleeding requiring surgery 23% and hemolysis 5%. Survival to discharge and 30 days was 58%. There was no significant difference in outcome by extent of device support used. More unstable pts tended to receive higher level support devices (CP, 5.0/LD). It is likely that higher level support devices are effective in more compromised pts. Probability of survival was significantly predicted from highest to lowest survival based on the following indications in order of support indication: Low cardiac output syndrome, Cardiogenic Shock and Failure to Wean (Figure). Conclusion: In this cVAD Registry analysis, Impella support provides competitive outcomes compared to prior MCS data with a suggestion that higher support devices are important for the most severe hemodynamic compromise. Further studies will be important to identify appropriate device choice.
Effect of Pre-Durable Mechanical Circulatory Support Device Anemia on Post-Device Implant Mortality S. Zalawadiya , J. Lindenfeld, K. Schlendorf, M. Danter, M. Djunaidi, M. Wigger, A. Shah, H. Ooi, S. Brown-Sacks, N. Haglund, M. Brinkley, M. Keebler. Vanderbilt University Medical Center, Nashville, TN. Purpose: Limited data exist evaluating the impact of anemia pre-durable mechanical circulatory support devices (MCSDs) on post-MCSD survival. Methods: We performed post-hoc analysis of 302 patients undergoing durable MCSD implantation between April 2009 and august 2016 in this single center study. Pre-MCSD hemoglobin (Hgb) was analyzed as both continuous and categorical variables. Pre-MCSD anemia was defined as blood hemoglobin (Hgb) level < 13 g/dL for male and < 12 g/dL for female. KaplanMeier survival estimates were compared using log-rank test for those with and without anemia. Cox-proportional hazard analyses were performed to assess relationship between anemia and post-MCSD mortality. Results: Anemia was highly prevalent at baseline (69.9%). Those with anemia were more likely to have lower body mass index (kg/m2; 28.8±5.6 versus (vs) 30.4±6.0), ischemic heart failure (52.1% vs 37.4%) and on intra-aortic balloon pump (22.3% vs 12.1%) at the time of MCSD implantation (p< 0.05 for all). Total of 83 deaths were observed over median follow up of 1 year. In the adjusted analysis, those with anemia were at significantly higher risk of post-MCSD mortality (see table 1 and figure 1) Conclusion: Pre-MCSD anemia was identified as significant risk marker for post-MCSD mortality. Future studies are required to assess impact of interventions aimed at correcting anemia and their relationship with post-MCSD mortality.
1( 332) Increasing Severity of Periprocedural Right Heart Failure Leads to Incrementally Worse Outcomes Following Left Ventricular Assist Device Implantation B. Lima ,1 A. Shaikh,1 K.M. Tecson,2 S. Still,1 J. Collier,1 R.D. Baxter,1 J. Felius,1 S.A. Hall,1 G.V. Gonzalez-Stawinski,1 S.M. Joseph.1 1Baylor University Medical Center, Dallas, TX; 2Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX. Purpose: Right heart failure (RHF) is a known risk factor for poor outcomes following left ventricular assist device (LVAD) implantation. While numerous predictive models of RHF have been proposed, stratification of outcomes based on RHF severity have not been studied. We examined the impact of increasing severity of postoperative RHF and associated risk factors.