TY - JOUR
T1 - Outcomes Associated with Obesity in Patients Undergoing Left Ventricular Assist Device Implantation
T2 - A Systematic Review and Meta-Analysis
AU - Khan, Muhammad Shahzeb
AU - Yuzefpolskaya, Melana
AU - Memon, Muhammad Mustafa
AU - Usman, Muhammad Shariq
AU - Yamani, Naser
AU - Garan, A. Reshad
AU - Demmer, Ryan T.
AU - Colombo, Paolo C.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Current data suggest that obesity does not impact survival, but may predispose patients to a higher rate of adverse events during left ventricular assist device (LVAD) support. We performed a systematic review and meta-analysis to assess the effects of obesity on clinical outcomes in LVAD recipients. We searched Medline, Scopus, Cochrane library, and clinicaltrials.gov from inception to February 2019 for studies comparing outcomes in obese (body mass index [BMI]> or ≥30 kg/m2) and nonobese (BMI< or ≤30 kg/m2) heart failure (HF) patients after LVAD implantation. Our primary endpoint was short-term (≤1 year) and long-term (>1 year) all-cause mortalities. The estimates are presented as random-effects risk ratios (RR) with 95% confidence intervals. In this meta-analysis of 15 observational studies (n = 26,842), obese patients receiving LVAD had significantly decreased 6 months (RR = 0.79 [0.73, 0.86]; p < 0.001, I2= 0%) and 1 year all-cause mortality (RR = 0.87 [0.79, 0.97]; p = 0.008, I2= 69%) compared with nonobese patients. However, both groups showed no significant difference in all-cause mortality at 2 years (RR = 0.95 [0.87, 1.04]; p = 0.12, I2= 55%) or 3 years (RR = 0.84 [0.61, 1.15]; p = 0.28, I2= 43%). Obese patients had significantly higher risk of device-related infections (RR = 1.48 [1.25, 1.75]; p < 0.001, I2= 37%), right heart failure (RR = 1.41 [1.21, 1.65]; p < 0.001, I2= 28%), and pump thrombosis (RR = 1.55 [1.37, 1.76]; p < 0.001, I2= 0%) compared with nonobese patients. This meta-analysis suggests that obese patients with HF have short- but not long-term survival benefit after LVAD implantation when compared to nonobese patients, although bias may have impacted these findings.
AB - Current data suggest that obesity does not impact survival, but may predispose patients to a higher rate of adverse events during left ventricular assist device (LVAD) support. We performed a systematic review and meta-analysis to assess the effects of obesity on clinical outcomes in LVAD recipients. We searched Medline, Scopus, Cochrane library, and clinicaltrials.gov from inception to February 2019 for studies comparing outcomes in obese (body mass index [BMI]> or ≥30 kg/m2) and nonobese (BMI< or ≤30 kg/m2) heart failure (HF) patients after LVAD implantation. Our primary endpoint was short-term (≤1 year) and long-term (>1 year) all-cause mortalities. The estimates are presented as random-effects risk ratios (RR) with 95% confidence intervals. In this meta-analysis of 15 observational studies (n = 26,842), obese patients receiving LVAD had significantly decreased 6 months (RR = 0.79 [0.73, 0.86]; p < 0.001, I2= 0%) and 1 year all-cause mortality (RR = 0.87 [0.79, 0.97]; p = 0.008, I2= 69%) compared with nonobese patients. However, both groups showed no significant difference in all-cause mortality at 2 years (RR = 0.95 [0.87, 1.04]; p = 0.12, I2= 55%) or 3 years (RR = 0.84 [0.61, 1.15]; p = 0.28, I2= 43%). Obese patients had significantly higher risk of device-related infections (RR = 1.48 [1.25, 1.75]; p < 0.001, I2= 37%), right heart failure (RR = 1.41 [1.21, 1.65]; p < 0.001, I2= 28%), and pump thrombosis (RR = 1.55 [1.37, 1.76]; p < 0.001, I2= 0%) compared with nonobese patients. This meta-analysis suggests that obese patients with HF have short- but not long-term survival benefit after LVAD implantation when compared to nonobese patients, although bias may have impacted these findings.
KW - left ventricular assist device
KW - mechanical circulatory support
KW - meta-analysis
KW - obesity
UR - http://www.scopus.com/inward/record.url?scp=85075405841&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075405841&partnerID=8YFLogxK
U2 - 10.1097/MAT.0000000000001019
DO - 10.1097/MAT.0000000000001019
M3 - Article
C2 - 31192852
AN - SCOPUS:85075405841
SN - 1058-2916
VL - 66
SP - 401
EP - 408
JO - ASAIO Journal
JF - ASAIO Journal
IS - 4
ER -