Morbidly obese patients requiring LVAD support encounter higher postoperative complications and wait longer for heart transplantation, however heart transplant and graft survival is comparable. Our study suggests that carefully selected morbidly obese patients should undergo LVAD placement and heart transplantation. However, our study was limited by a very small sample size and by the biases inherent to a retrospective data analysis

Cohen, Sophia

Tang, Daniel, MD

VCU Scholars Compass

Virginia Commonwealth University
VCU Scholars Compass
MD Student Summer Research Fellowship Program
Posters School of Medicine
2016
Impact of Morbid Obesity on Left Ventricular
Assist Device Support and Heart Transplantation
Sophia Cohen
Virginia Commonwealth University
Daniel Tang MD
Virginia Commonwealth University
Follow this and additional works at: https://scholarscompass.vcu.edu/mds_posters
Part of the Medicine and Health Sciences Commons
This Poster is brought to you for free and open access by the School of Medicine at VCU Scholars Compass. It has been accepted for inclusion in MD
Student Summer Research Fellowship Program Posters by an authorized administrator of VCU Scholars Compass. For more information, please
contact libcompass@vcu.edu.
Downloaded from
https://scholarscompass.vcu.edu/mds_posters/6
Introduction
Methods
Results Results
References
The current standard of treatment for 
patients with end stage heart failure is 
cardiac transplantation, however, the pool 
of viable donor hearts is not adequate to 
meet the needs of patients with end stage 
heart failure1. This discrepancy has lead to 
the increasing use of continuous flow (CF) 
left ventricular assist devices (LVADs) as a 
bridge to transplant (BTT)2. Patient 
selection is an important predictor of 
outcomes for both LVAD support and Heart 
Transplantation. Morbid obesity, which is a 
BMI ≥ 40, or a BMI ≥ 35 with 
comorbidities3, carries increased risk for 
LVAD placement4 and is a relative 
contraindication for heart transplantation5. 
A higher BMI puts patients at increased 
risk for postoperative complications6. To 
better understand how to best treat heart 
failure in the morbidly obese, we analyzed 
data from patients receiving a CF LVAD 
and heart transplantation to asses the 
association between BMI, complications, 
wait time for transplantation and survival. 
The study was comprised of 157 patients 
with advanced heart failure who received a 
CF LVAD  at Virginia Commonwealth 
University Hospital from December 2008 
through January 2014. We retrospectively 
collected data on each patient from the 
Society of Thoracic Surgeons (STS) and 
Interagency Registry for Mechanically 
Assisted Circulatory Support 
(INTERMACS) databases. The data was 
analyzed by dividing patients into two 
groups, BMI ≥ 35 and BMI < 35.
Morbidly obese patients requiring LVAD 
support encounter higher postoperative 
complications and wait longer for heart 
transplantation, however heart transplant 
and graft survival is comparable. 
Our study suggests that carefully selected 
morbidly obese patients should undergo 
LVAD placement and heart transplantation.  
However, our study was limited by a very 
small sample size and by the biases 
inherent to a retrospective data analysis. 
Impact of Morbid Obesity on Left Ventricular Assist Device Support and Heart Transplantation
S. Cohen1, L. Wolfe1, D. Tang1, G. Katlaps1, V. Kasirajan1, K. Shah2, R. Cooke3, M. Smallfield3, I. Tchoukina3, K. Rao3, M. Quader1.1Cardio-Thoracic Surgery, 
Virginia Commonwealth University, Richmond, VA, 2Cardiology, Virginia Commonwealth University, Richmond, VA, 3Cardiology, Virginia Commonwealth 
University, Richmond, VA
0
0.2
0.4
0.6
0.8
1
0 6 12 18 24 30 36 42 48 54 60P
at
ie
nt
 S
ur
vi
va
l
Months
Patient Survival After Heart Tx
BMI < 35 BMI ≥ 35
p = 0.7378 by Log-Rank Test
BMI ≥ 35 kg/m2
n=36 (23%)
BMI <35 
kg/m2
n=121 (77%)
P-value
Age in years 47 ± 12.7 55 ± 13.4 0.001
BMI 41.6 ± 5.5 27.8 ± 4.1
Preoperative Comorbidities
Cerebrovascular  Disease 5.6% 17% 0.11
Diabetes 44% 47% 0.85
Prior MI 22% 46% 0.01
Cardiac Arrhythmia 36% 63% 0.01
Implantation Designation
Bridge to Transplant 61% 61%
Bridge to Recovery 3% 7%
Destination 36% 31%
Hemodynamics (mmHg)
Right atrial pressure 18.3 ± 8.8 13.3 ± 5.7 0.004
PCWP 32.4 ± 9.0 27.8 ± 8.0 0.01
Mean PAP 44.7 ± 7.9 38.7 ± 9.6 0.001
Table I. Pre-operative Patient Characteristics 
BMI, body mass index; LVAD, left ventricular assist device; PCWP, 
pulmonary capillary wedge pressure; PAP, Pulmonary artery pressure
BMI ≥ 35 
kg/m2
n=36
BMI <35 
kg/m2
n=121
P-value
Bleeding 
requiring 
reoperation
42% 22% 0.03
Operative 
mortality 
19.5% 11% 0.25
Device Related 
Complications
65% 62% 0.84
Driveline
Infection
Frequency
2.4 ± 1.7 1.2 ± 0.5 0.02
Driveline 
Infection 24% 26% 1
Device 
Thrombosis
26.5% 12% 0.056
Hemolysis 26% 11% 0.05
Stroke 24% 12% 0.10
GI Bleed 20% 26.5% 0.51
Wait time to 
transplant 
(days)
619 ± 372 404 ±
342
0.10
Table II. Post-operative Outcomes and 
Device Related Complications
BMI ≥ 35 kg/m2
n=7
BMI <35 kg/m2
n=41 
P-value
Heart Transplant received in 19% 33% 0.15
Bleeding requiring reoperation 57% 15% 0.03
Length of Hospital Stay (days) 45 ± 43 27 ± 21 0.42
HTx survival at 2.3 ± 1.6 yrs follow up 86% 93% 0.49
Table III. Heart Transplantation 
• 157 LVADs implanted, 121 (77%) BMI <35 and 36 (23%) BMI ≥ 35.
• BMI ≥ 35 group was of 7 years younger, had higher hemodynamics and had fewer prior 
myocardial infarctions, arrythmias, and cardiac surgeries. 
• Both groups had comparable preop morbidities, INTERMACS class, LVAD type and 
implantation designation. 
• Postop and device specific complications were higher in BMI ≥35 group, but only bleeding 
requiring reoperation and frequency of driveline infections were statistically significant. 
• Operative mortality higher in BMI ≥35 group but wasn’t statistically significant (19.5% vs 11%).
• Patients with a BMI ≥ 35 spent an average of 216 more days on the wait list, with an average of 
(619 ± 372 vs 403 ± 342 days) and fewer patients received a HTx (19% vs. 33% p = 0.15) 
• After HTx, BMI ≥35 group had higher postop bleeding requiring reoperation (57% vs 15%).
• HTx survival and graft survival was comparable in both groups.  Discussion
1. Taylor DO, Edwards LB, Aurora P, et al. Registry of the International 
Society for Heart and Lung Transplantation: twenty-fifth official adult heart 
transplant report—2008. J Heart Lung Transplant 2008;27: 943-56. 
2. Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device 
in patients awaiting heart transplantation. N Engl J Med 2007;357:885-96. 
3. NIH conference. Gastrointestinal surgery for severe obesity. Consensus 
Development Conference Panel. Ann Intern Med 1991;115:956-61.
4. Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International 
Society for Heart and Lung Transplantation Guidelines for mechanical 
circulatory support: executive summary. J Heart Lung Transplant 
2013;32:157-87.
5. Mancini D, Lietz K. Selection of cardiac transplantation candidates in 
2010. Circulation 2010;122:173-83.  
6. Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery 
in obese patients. Ann Int Med 1986;104:540–6. 


English

Impact of Morbid Obesity on Left Ventricular Assist Device Support and Heart Transplantation

Virginia Commonwealth UniversityVCU Scholars CompassMD Student Summer Research Fellowship ProgramPosters School of Medicine2016Impact of Morbid Obesity on Left VentricularAssist Device Support and Heart TransplantationSophia CohenVirginia Commonwealth University, cohense2@vcu.eduDaniel Tang MDVirginia Commonwealth University, daniel.tang@vcuhealth.orgFollow this and additional works at: http://scholarscompass.vcu.edu/mds_postersPart of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the School of Medicine at VCU Scholars Compass. It has been accepted for inclusion in MDStudent Summer Research Fellowship Program Posters by an authorized administrator of VCU Scholars Compass. For more information, pleasecontact libcompass@vcu.edu.Downloaded fromhttp://scholarscompass.vcu.edu/mds_posters/6IntroductionMethodsResults ResultsReferencesThe current standard of treatment for patients with end stage heart failure is cardiac transplantation, however, the pool of viable donor hearts is not adequate to meet the needs of patients with end stage heart failure1. This discrepancy has lead to the increasing use of continuous flow (CF) left ventricular assist devices (LVADs) as a bridge to transplant (BTT)2. Patient selection is an important predictor of outcomes for both LVAD support and Heart Transplantation. Morbid obesity, which is a BMI ≥ 40, or a BMI ≥ 35 with comorbidities3, carries increased risk for LVAD placement4 and is a relative contraindication for heart transplantation5. A higher BMI puts patients at increased risk for postoperative complications6. To better understand how to best treat heart failure in the morbidly obese, we analyzed data from patients receiving a CF LVAD and heart transplantation to asses the association between BMI, complications, wait time for transplantation and survival. The study was comprised of 157 patients with advanced heart failure who received a CF LVAD  at Virginia Commonwealth University Hospital from December 2008 through January 2014. We retrospectively collected data on each patient from the Society of Thoracic Surgeons (STS) and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) databases. The data was analyzed by dividing patients into two groups, BMI ≥ 35 and BMI < 35.Morbidly obese patients requiring LVAD support encounter higher postoperative complications and wait longer for heart transplantation, however heart transplant and graft survival is comparable. Our study suggests that carefully selected morbidly obese patients should undergo LVAD placement and heart transplantation.  However, our study was limited by a very small sample size and by the biases inherent to a retrospective data analysis. Impact of Morbid Obesity on Left Ventricular Assist Device Support and Heart TransplantationS. Cohen1, L. Wolfe1, D. Tang1, G. Katlaps1, V. Kasirajan1, K. Shah2, R. Cooke3, M. Smallfield3, I. Tchoukina3, K. Rao3, M. Quader1.1Cardio-Thoracic Surgery, Virginia Commonwealth University, Richmond, VA, 2Cardiology, Virginia Commonwealth University, Richmond, VA, 3Cardiology, Virginia Commonwealth University, Richmond, VA00.20.40.60.810 6 12 18 24 30 36 42 48 54 60Patient SurvivalMonthsPatient Survival After Heart TxBMI < 35 BMI ≥ 35p = 0.7378 by Log-Rank TestBMI ≥ 35 kg/m2n=36 (23%)BMI <35 kg/m2n=121 (77%)P-valueAge in years 47 ± 12.7 55 ± 13.4 0.001BMI 41.6 ± 5.5 27.8 ± 4.1Preoperative ComorbiditiesCerebrovascular  Disease 5.6% 17% 0.11Diabetes 44% 47% 0.85Prior MI 22% 46% 0.01Cardiac Arrhythmia 36% 63% 0.01Implantation DesignationBridge to Transplant 61% 61%Bridge to Recovery 3% 7%Destination 36% 31%Hemodynamics (mmHg)Right atrial pressure 18.3 ± 8.8 13.3 ± 5.7 0.004PCWP 32.4 ± 9.0 27.8 ± 8.0 0.01Mean PAP 44.7 ± 7.9 38.7 ± 9.6 0.001Table I. Pre-operative Patient Characteristics BMI, body mass index; LVAD, left ventricular assist device; PCWP, pulmonary capillary wedge pressure; PAP, Pulmonary artery pressureBMI ≥ 35 kg/m2n=36BMI <35 kg/m2n=121P-valueBleeding requiring reoperation42% 22% 0.03Operative mortality 19.5% 11% 0.25Device Related Complications65% 62% 0.84DrivelineInfectionFrequency2.4 ± 1.7 1.2 ± 0.5 0.02Driveline Infection 24% 26% 1Device Thrombosis26.5% 12% 0.056Hemolysis 26% 11% 0.05Stroke 24% 12% 0.10GI Bleed 20% 26.5% 0.51Wait time to transplant (days)619 ± 372 404 ±3420.10Table II. Post-operative Outcomes and Device Related ComplicationsBMI ≥ 35 kg/m2n=7BMI <35 kg/m2n=41 P-valueHeart Transplant received in 19% 33% 0.15Bleeding requiring reoperation 57% 15% 0.03Length of Hospital Stay (days) 45 ± 43 27 ± 21 0.42HTx survival at 2.3 ± 1.6 yrs follow up 86% 93% 0.49Table III. Heart Transplantation • 157 LVADs implanted, 121 (77%) BMI <35 and 36 (23%) BMI ≥ 35.• BMI ≥ 35 group was of 7 years younger, had higher hemodynamics and had fewer prior myocardial infarctions, arrythmias, and cardiac surgeries. • Both groups had comparable preop morbidities, INTERMACS class, LVAD type and implantation designation. • Postop and device specific complications were higher in BMI ≥35 group, but only bleeding requiring reoperation and frequency of driveline infections were statistically significant. • Operative mortality higher in BMI ≥35 group but wasn’t statistically significant (19.5% vs 11%).• Patients with a BMI ≥ 35 spent an average of 216 more days on the wait list, with an average of (619 ± 372 vs 403 ± 342 days) and fewer patients received a HTx (19% vs. 33% p = 0.15) • After HTx, BMI ≥35 group had higher postop bleeding requiring reoperation (57% vs 15%).• HTx survival and graft survival was comparable in both groups.  Discussion1. Taylor DO, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008. J Heart Lung Transplant 2008;27: 943-56. 2. Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 2007;357:885-96. 3. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 1991;115:956-61.4. Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 2013;32:157-87.5. Mancini D, Lietz K. Selection of cardiac transplantation candidates in 2010. Circulation 2010;122:173-83.  6. Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery in obese patients. Ann Int Med 1986;104:540–6. 

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Impact of Morbid Obesity on Left Ventricular Assist Device Support and Heart Transplantation

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