Outcomes of Obese Patients Bridged to Heart Transplantation with a Left Ventricular Assist Device
| Autor: | Mark J. Russo, Joseph Heaton, Nawar Al-Obaidi, Rajiv Tayal, Darko Vucicevic, Mark J. Zucker, Leonard Y. Lee, Margarita Camacho, Alexis K. Okoh, Mariam Selevany |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Biomedical Engineering Biophysics Bioengineering 030204 cardiovascular system & hematology Body Mass Index Biomaterials 03 medical and health sciences 0302 clinical medicine Weight loss Classification of obesity Internal medicine Weight Loss medicine Humans Obesity Heart Failure Heart transplantation business.industry Incidence (epidemiology) General Medicine Middle Aged medicine.disease Transplantation Treatment Outcome 030228 respiratory system Ventricular assist device Heart Transplantation Female Heart-Assist Devices medicine.symptom business Body mass index |
| Zdroj: | ASAIO Journal. 67:137-143 |
| ISSN: | 1058-2916 |
| DOI: | 10.1097/mat.0000000000001188 |
| Popis: | The current study aims to investigate the impact of left ventricular assist device (LVAD) implantation on weight loss and functional status in obese patients bridged to transplantation (BTT). The United Network for Organ Sharing (UNOS) database was queried to identify patients with body mass index (BMI) ≥ 30 who underwent LVAD implantation as BTT from 2008 to 2018. Patients were divided into three groups based the World Health Organization classification of obesity: obesity class I (BMI, 30.0-34.9 kg/m2), obesity class II (BMI, 35-39.9 kg/m2), and obesity class III (BMI, >40 kg/m2). Patients with incomplete data on BMI were excluded. The primary outcome was a change in BMI while listed. Secondary outcomes included a change in functional status after LVAD implantation and posttransplant morbidity and survival. Out of 14,191 patients who had an LVAD while listed within the study period, 5,354 (37.7%) had a BMI ≥30 kg/m2. Obesity was classified as class I in 3,909 (73%), class II in 1,275 (23.8%), and class III in 170 (3.2%) patients. Among patients with complete data on BMI, 18.9% (n = 394) reported a change in BMI, leading to an improvement in their obesity class, and this was similar for all obesity classes (22% [n = 331], 50% [n = 111], and 60% [n = 43] for classes I, II, and III, respectively). All groups reported an improvement in functional status (65% vs. 62% and 61% for classes I, II, and III, respectively). Posttransplant survival was not significantly different between obese groups (p = 0.787). Compared with classes I and II, the incidence of thrombosis (p = 0.0006) and device malfunction (p = 0.036) was significantly higher in the class III group. About one out of every five obese patients listed for heart transplantation with an LVAD loses weight, leading to a change in their BMI class. Most patients reported a significant improvement in their functional status. Among those successfully BTT, posttransplant survival was similar. |
| Databáze: | OpenAIRE |
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