title: Higher Body Mass Index Increases Risk of HeartMate II Pump Thrombosis But Does Not Adversely Affect Long-Term Survival.
abstract: Obesity has been correlated with various adverse events in patients who receive left ventricular assist devices (LVAD). In this study, we sought to further characterize the role of obesity in this patient population.
  
  
  
  We performed a retrospective analysis of 164 patients implanted with a HeartMate II from August 2008 to December 2014. Patients were categorized into 2 BMI groups based on WHO guidelines: BMI 18.5-30 kg/m2(n=99) and BMI >30 kg/m2(n=65). Patient demographics, adverse outcome and long-term survival were compared between the 2 groups. For any outcome associated with BMI groups, we performed a Cox regression to identify confounding comorbidities. Preoperative demographics and comorbidities were similar. Patients with BMI >30 were younger (P=0.01) and had a higher incidence of type 2 diabetes (P=0.01). While rate of pump thrombosis was higher among patients with BMI >30 (P=0.02), overall survival at 2 years did not differ. The most common cause of death was hemorrhagic stroke in the obese group. On multivariable cox regression analysis, BMI was an independent risk factor of pump thrombosis.
  
  
  
  Higher BMI does not reduce survival after VAD implantation but it does appear to increase the risk of pump thrombosis. Further studies to characterize the role of BMI in survival and thrombosis rates are warranted.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Han
authors.forename: Renganaden
authors.initials: R
authors.lastname: Sooppan
authors.forename: Adam P
authors.initials: AP
authors.lastname: Johnson
authors.forename: Carol W
authors.initials: CW
authors.lastname: Chen
authors.forename: Ann C
authors.initials: AC
authors.lastname: Gaffey
authors.forename: Emily C
authors.initials: EC
authors.lastname: Phillips
authors.forename: Jessica
authors.initials: J
authors.lastname: Howard
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Rame
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000628:therapy