title: Destination therapy: one-year outcomes in patients with a body mass index greater than 30.
abstract: Left ventricular assist devices (LVADs) are slowly gaining acceptance as the treatment of choice in appropriately selected patients with end-stage heart failure who are not transplant candidates. Obesity is a well-known risk factor for increased cardiovascular morbidity and mortality, and frequently can be the reason some patients are turned down for heart transplantation. Because of this experience in transplant patients, many centers have also been reluctant to offer these patients an LVAD for destination therapy (DT). Subsequently, the 1-year outcomes of obese patients receiving LVADs for DT at our center were reviewed. Fifty-eight consecutive patients (83% men) were implanted with HeartMate XVE (n = 22) or HeartMate II (n = 36) LVAD. Patients were divided into normal (body mass index [BMI] <or= 30 kg/m(2), n = 38) and obese (BMI >or= 30 kg/m(2), n = 20) groups according to their BMI. Preoperatively, there were statistically significant differences (P < 0.05) between normal and obese groups in age (65.9 years vs. 54.7 years), weight (72.9 kg vs. 107.5 kg), BMI (24.1 kg/m(2) vs. 35.2 kg/m(2)), and incidence of diabetes (37% vs. 60%). At 1-year follow-up, there were no statistically significant differences (P > 0.5) between normal and obese groups: creatinine levels (1.4 vs. 1.5), New York Heart Association classification (1.2 vs. 1.6), and survival (63% vs. 65%). Our initial results demonstrate that morbidly obese patients with end-stage heart failure with a contraindication for transplant may successfully undergo implantation of an LVAD for DT.
authors.affiliation: Mechanical Assist Device Program, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Coyle
authors.forename: Mickey S
authors.initials: MS
authors.lastname: Ising
authors.forename: Colleen
authors.initials: C
authors.lastname: Gallagher
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
authors.forename: Sudha
authors.initials: S
authors.lastname: Kurien
authors.forename: Michael A
authors.initials: MA
authors.lastname: Sobieski
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality / Q000601:surgery; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome