PMID- 30195832 OWN - NLM STAT- MEDLINE DCOM- 20200127 LR - 20200127 IS - 1557-3117 (Electronic) IS - 1053-2498 (Print) IS - 1053-2498 (Linking) VI - 37 IP - 10 DP - 2018 Oct TI - Impact of body mass index on adverse events after implantation of left ventricular assist devices: An IMACS registry analysis. PG - 1207-1217 LID - S1053-2498(18)31505-5 [pii] LID - 10.1016/j.healun.2018.06.004 [doi] AB - BACKGROUND: Limited data exist describing impact of body mass index (BMI) on post‒left ventricular assist device (post-LVAD) outcomes. We sought to define the relationship between body mass index (BMI) and adverse events (AEs) after LVAD implantation by examining the ISHLT Mechanically Assisted Circulatory Support (IMACS) registry. METHODS: Patients implanted with a contemporary continuous flow (CF)-LVAD were stratified into 4 groups using pre-operative BMI: underweight (UW; BMI 18.5 to <30 kg/m(2)); obese (OB; BMI >/=30 to <40 kg/m(2)); and morbidly obese (MO; BMI >/=40 kg/m(2)). Freedom from AEs was evaluated using the Kaplan-Meier method and risk factors for development of first AE were identified using multiphase parametric hazard modeling. AEs included infection, thromboembolic events, bleeding, device malfunction, and neurologic dysfunction. RESULTS: Between 2013 and 2015, a total of 9,408 patients underwent implantation of a CF-LVAD, which consisted of 368 (4%) UW, 5,719 (61%) NO, 2,770 (29%) OB, and 444 (5%) MO patients. Survival among the 4 BMI cohorts was similar at 2years (70.8% to 75.8%, p = 0.24). MO patients were less likely to be free from a non‒VAD-related infection (p < 0.0001) or device-related infection (p = 0.0014) at 2years (50.3%, 70.7%) when compared with OB (58.3%, 78.7%), NO (65.2%, 81.4%), and UW (68.9%, 77.4%) patients. UW (81.5%) and NO (81.3%) patients were more likely to be free from device malfunction at 2years when compared with OB (78.3%) and MO (72.6%) (p = 0.0006). Thromboembolic events were rare and more common in the UW cohort (p = 0.026). CONCLUSIONS: Although BMI was not correlated with 2-year mortality, an increased rate of infectious and device-related AEs was noted in OB and MO LVAD patients. In a group with few options for transplant, the event morbidity in obese patients can be expected to impact morbidity with longer support durations. CI - Copyright (c) 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. FAU - Forest, Stephen J AU - Forest SJ AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. Electronic address: sforest@montefiore.org. FAU - Xie, Rongbing AU - Xie R AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Kirklin, James K AU - Kirklin JK AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Cowger, Jennifer AU - Cowger J AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Xia, Yu AU - Xia Y AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Dipchand, Anne I AU - Dipchand AI AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Sivathasan, Cumara AU - Sivathasan C AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Merry, Chris AU - Merry C AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Lund, Lars H AU - Lund LH AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Kormos, Robert AU - Kormos R AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Hannan, Margaret M AU - Hannan MM AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Nakatani, Takeshi AU - Nakatani T AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Jorde, Ulrich AU - Jorde U AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Goldstein, Daniel J AU - Goldstein DJ AD - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA. LA - eng GR - HHSN268201100025C/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20180621 PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 SB - IM MH - *Body Mass Index MH - Cause of Death MH - Cohort Studies MH - Heart-Assist Devices/*adverse effects MH - Humans MH - Kaplan-Meier Estimate MH - Likelihood Functions MH - Postoperative Complications/*etiology/mortality MH - Proportional Hazards Models MH - *Registries MH - Risk Factors MH - Survival Rate MH - Thromboembolism/etiology/mortality MH - United States MH - Ventricular Dysfunction, Left/mortality/*surgery PMC - PMC6175660 MID - NIHMS1505968 EDAT- 2018/09/10 06:00 MHDA- 2020/01/28 06:00 PMCR- 2019/10/01 CRDT- 2018/09/10 06:00 PHST- 2018/02/07 00:00 [received] PHST- 2018/05/04 00:00 [revised] PHST- 2018/06/06 00:00 [accepted] PHST- 2018/09/10 06:00 [pubmed] PHST- 2020/01/28 06:00 [medline] PHST- 2018/09/10 06:00 [entrez] PHST- 2019/10/01 00:00 [pmc-release] AID - S1053-2498(18)31505-5 [pii] AID - 10.1016/j.healun.2018.06.004 [doi] PST - ppublish SO - J Heart Lung Transplant. 2018 Oct;37(10):1207-1217. doi: 10.1016/j.healun.2018.06.004. Epub 2018 Jun 21.