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Impact of Change in Body Mass Index on Outcomes After Left Ventricular Assist Device Implantation in Obese Patients
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The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017
V. Cotarlan ,1 F. Johnson,1 J. Franzwa,1 C. Inampudi,1 U. Emerenini,1 R. Tandon,1 R. Tahir,2 Y. Nabeel,1 J. Goerbig,3 K. Light-McGroary,1 G. Goldsmith,1 M. Giudici.1 1Univ of Iowa Hospital, Iowa City, IA; 2Geisinger Medical Center, Danville, PA; 3Iowa Heart Center, Des Moines, IA. Purpose: The aim of the study was to assess the hemodynamic benefits of biventricular(BiV) pacing in patients supported by left ventricular assist devices (LVAD). Methods: We studied 22 patients supported by LVAD (age 62±9, 22 males) who had received BiV PM prior to LVAD implant. A total of 121 complete sets of hemodynamics were obtained in pairs at the same heart rate (HR) during both BiV (n= 53) and RV(n= 53) pacing at rates ranging 50 to 110 bpm as well as intrinsic rhythm (n= 15) for non PM dependent patients. Cardiac rhythm was sinus (7 patients), atrial fibrillation (14 patients),12 post AVN ablation. Results: There were no significant differences in right atrial(RA) pressure, mean pulmonary artery pressure(mPA), pulmonary capillary wedge pressure (PCWP), cardiac output(CO), PA saturation(PASat) and right ventricular stroke work(RVSW) between BiV and RV pacing. Overall, hemodynamics obtained during intrinsic rhythm in 15 non-PM dependent patients were not significantly different compared to those obtained during BiV or RV pacing (table 1). However, one patient with previous AVN ablation who was tested during a slow junctional escape rhythm had a mild decrease in CO and PA Saturation. Furthermore, hemodynamics were also similar at different tested pacing rates ranging 50 to 110 bpm. There was a trend for higher RVSW at the lowest compared to highest tested HR (table 2). Conclusion: BiV pacing does not seem to have acute hemodynamic benefit compared to RV pacing or intrinsic rhythm in LVAD patients. A lower HR may confer better RV performance. Larger studies to assess the long term clinical benefits of biventricular pacing and potential benefit of lowering HR in LVAD patients are warranted.
Methods: Fifty-nine patients who received continuous-flow LVADs between January 2010 and June 2015 and whose BMI were greater than 30 kg/m2 at the time of LVADs implantation were retrospectively analyzed. Patients were divided into two groups based upon whether BMI after six months of device support decreased as compared to before implantation. Thirty-eight patients who experienced decrease in BMI (Group D) were compared with 21 patients whose BMI increased (Group I). Results: Baseline characteristics were similar between the both groups except for body weight and BMI, which were significantly higher in group D compared to group I (111.6 ± 14.5 kg vs. 101.9 ± 13.2 kg; p = 0.013 and 35.9 ± 4.0 kg/m2 vs. 33.4 ± 3.5 kg/m2; p = 0.018, respectively). At six months, the patients in group D showed significant reduction in BMI whereas the patients in group I increased BMI. (BMI; 33.2 ± 4.0 kg/m2 vs. 35.6 ± 3.6; p = 0.03, delta BMI: -2.7 ± 2.3 kg/m2 vs. 2.2 ± 1.4; p < 0.01). During mean follow-up of 560 ± 178 days, the patients in group I had significantly higher incidence of device-related infection (16% vs. 43%; p = 0.022) and sepsis (16% vs. 43%; p = 0.022). The incidence of heart failure exacerbation required aggressive intervention tended to be higher in the patients in group I (8% vs. 24%; p = 0.097). Survival at two years was significantly lower in group I compared to group D (84.8 % vs. 57.1 %; p = 0.025). Conclusion: Increase in BMI in obese patients on LVADs was associated with worse survival with significantly higher incidence of device-related infection as well as sepsis. BMI control after LVADs in obese patients would be a useful intervention for better prognosis.
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1( 064) Impact of Change in Body Mass Index on Outcomes After Left Ventricular Assist Device Implantation in Obese Patients A. Mano . Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Osaka, Japan. Purpose: Obesity could be a factor related to prognosis after left ventricular assist devices (LVADs) implantation. However, the relationship between weight change and outcomes in obese patients remains unknown. We sought to determine the impact of change in body mass index (BMI) on outcomes in obese patients supported by LVADs.
Not All INTERMACS Level 1’s Are the Same: Survival After Total Artificial Heart Implantation with or without Temporary Circulatory Support H.J. Reich ,1 D. Ramzy,2 J. Mirocha,2 M.A. De Robertis,2 J. Chung,2 F. Esmailian,2 D. Chang,3 J. Moriguchi,3 L. Czer,3 A. Trento,2 F. Arabia.2 1Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; 2Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA; 3Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA. Purpose: Total artificial heart (TAH) implantation for Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1 patients was reported to have lower survival to transplant than Levels 2-4. We hypothesize that Level 1 “crash & burn” patients undergoing TAH implantation with critical cardiogenic shock are clinically heterogeneous & subsets have excellent clinical outcomes. Methods: Records of all Level 1 TAH implants at Cedars-Sinai Medical Center from 2013-15 were retrospectively reviewed. Patient characteristics & survival were collected & compared between groups with no INTERMACS Level Modifier, Modifier A (arrhythmia) or Modifier TCS (temporary circulatory support) using Wilcoxon, log-rank & Fisher’s exact tests. Results: Thirty-two Level 1 patients underwent TAH implantation as bridge to heart transplantation: 24 males (75%) with mean age 49.4±13.6 years. Preoperative creatinine (1.8±1.0 vs. 1.6±0.6, p= 0.89) & total bilirubin (3.3±2.9 vs. 2.1±1.8, p= 0.20) were similar for patients with vs. without TCS. Survival at 6 & 12 months after implantation was 62.5% & 59.4%. Survival to transplant was 53.1%. Survival at 6 & 12 months post-transplant was 100% & 92.9%. Sample size for patients with Modifier A was too small for comparison (n= 2).
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017
V. Cotarlan ,1 F. Johnson,1 J. Franzwa,1 C. Inampudi,1 U. Emerenini,1 R. Tandon,1 R. Tahir,2 Y. Nabeel,1 J. Goerbig,3 K. Light-McGroary,1 G. Goldsmith,1 M. Giudici.1 1Univ of Iowa Hospital, Iowa City, IA; 2Geisinger Medical Center, Danville, PA; 3Iowa Heart Center, Des Moines, IA. Purpose: The aim of the study was to assess the hemodynamic benefits of biventricular(BiV) pacing in patients supported by left ventricular assist devices (LVAD). Methods: We studied 22 patients supported by LVAD (age 62±9, 22 males) who had received BiV PM prior to LVAD implant. A total of 121 complete sets of hemodynamics were obtained in pairs at the same heart rate (HR) during both BiV (n= 53) and RV(n= 53) pacing at rates ranging 50 to 110 bpm as well as intrinsic rhythm (n= 15) for non PM dependent patients. Cardiac rhythm was sinus (7 patients), atrial fibrillation (14 patients),12 post AVN ablation. Results: There were no significant differences in right atrial(RA) pressure, mean pulmonary artery pressure(mPA), pulmonary capillary wedge pressure (PCWP), cardiac output(CO), PA saturation(PASat) and right ventricular stroke work(RVSW) between BiV and RV pacing. Overall, hemodynamics obtained during intrinsic rhythm in 15 non-PM dependent patients were not significantly different compared to those obtained during BiV or RV pacing (table 1). However, one patient with previous AVN ablation who was tested during a slow junctional escape rhythm had a mild decrease in CO and PA Saturation. Furthermore, hemodynamics were also similar at different tested pacing rates ranging 50 to 110 bpm. There was a trend for higher RVSW at the lowest compared to highest tested HR (table 2). Conclusion: BiV pacing does not seem to have acute hemodynamic benefit compared to RV pacing or intrinsic rhythm in LVAD patients. A lower HR may confer better RV performance. Larger studies to assess the long term clinical benefits of biventricular pacing and potential benefit of lowering HR in LVAD patients are warranted.
Methods: Fifty-nine patients who received continuous-flow LVADs between January 2010 and June 2015 and whose BMI were greater than 30 kg/m2 at the time of LVADs implantation were retrospectively analyzed. Patients were divided into two groups based upon whether BMI after six months of device support decreased as compared to before implantation. Thirty-eight patients who experienced decrease in BMI (Group D) were compared with 21 patients whose BMI increased (Group I). Results: Baseline characteristics were similar between the both groups except for body weight and BMI, which were significantly higher in group D compared to group I (111.6 ± 14.5 kg vs. 101.9 ± 13.2 kg; p = 0.013 and 35.9 ± 4.0 kg/m2 vs. 33.4 ± 3.5 kg/m2; p = 0.018, respectively). At six months, the patients in group D showed significant reduction in BMI whereas the patients in group I increased BMI. (BMI; 33.2 ± 4.0 kg/m2 vs. 35.6 ± 3.6; p = 0.03, delta BMI: -2.7 ± 2.3 kg/m2 vs. 2.2 ± 1.4; p < 0.01). During mean follow-up of 560 ± 178 days, the patients in group I had significantly higher incidence of device-related infection (16% vs. 43%; p = 0.022) and sepsis (16% vs. 43%; p = 0.022). The incidence of heart failure exacerbation required aggressive intervention tended to be higher in the patients in group I (8% vs. 24%; p = 0.097). Survival at two years was significantly lower in group I compared to group D (84.8 % vs. 57.1 %; p = 0.025). Conclusion: Increase in BMI in obese patients on LVADs was associated with worse survival with significantly higher incidence of device-related infection as well as sepsis. BMI control after LVADs in obese patients would be a useful intervention for better prognosis.
1( 065)
1( 064) Impact of Change in Body Mass Index on Outcomes After Left Ventricular Assist Device Implantation in Obese Patients A. Mano . Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Osaka, Japan. Purpose: Obesity could be a factor related to prognosis after left ventricular assist devices (LVADs) implantation. However, the relationship between weight change and outcomes in obese patients remains unknown. We sought to determine the impact of change in body mass index (BMI) on outcomes in obese patients supported by LVADs.
Not All INTERMACS Level 1’s Are the Same: Survival After Total Artificial Heart Implantation with or without Temporary Circulatory Support H.J. Reich ,1 D. Ramzy,2 J. Mirocha,2 M.A. De Robertis,2 J. Chung,2 F. Esmailian,2 D. Chang,3 J. Moriguchi,3 L. Czer,3 A. Trento,2 F. Arabia.2 1Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; 2Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA; 3Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA. Purpose: Total artificial heart (TAH) implantation for Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1 patients was reported to have lower survival to transplant than Levels 2-4. We hypothesize that Level 1 “crash & burn” patients undergoing TAH implantation with critical cardiogenic shock are clinically heterogeneous & subsets have excellent clinical outcomes. Methods: Records of all Level 1 TAH implants at Cedars-Sinai Medical Center from 2013-15 were retrospectively reviewed. Patient characteristics & survival were collected & compared between groups with no INTERMACS Level Modifier, Modifier A (arrhythmia) or Modifier TCS (temporary circulatory support) using Wilcoxon, log-rank & Fisher’s exact tests. Results: Thirty-two Level 1 patients underwent TAH implantation as bridge to heart transplantation: 24 males (75%) with mean age 49.4±13.6 years. Preoperative creatinine (1.8±1.0 vs. 1.6±0.6, p= 0.89) & total bilirubin (3.3±2.9 vs. 2.1±1.8, p= 0.20) were similar for patients with vs. without TCS. Survival at 6 & 12 months after implantation was 62.5% & 59.4%. Survival to transplant was 53.1%. Survival at 6 & 12 months post-transplant was 100% & 92.9%. Sample size for patients with Modifier A was too small for comparison (n= 2).