Han Jason J, Sooppan Renganaden, Johnson Adam P, Chen Carol W, Gaffey Ann C, Phillips Emily C, Howard Jessica, Rame J Eduardo, Acker Michael A, Atluri Pavan
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania.
Circ J. 2017 Jan 25;81(2):213-219. doi: 10.1253/circj.CJ-16-0942. Epub 2016 Dec 22.
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/m(n=99) and BMI >30 kg/m(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.
肥胖与接受左心室辅助装置（LVAD）的患者发生的各种不良事件相关。在本研究中，我们试图进一步明确肥胖在该患者群体中的作用。
我们对2008年8月至2014年12月期间植入HeartMate II的164例患者进行了回顾性分析。根据世界卫生组织指南，将患者分为2个BMI组：BMI 18.5 - 30 kg/m²（n = 99）和BMI > 30 kg/m²（n = 65）。比较两组患者的人口统计学特征、不良结局和长期生存率。对于任何与BMI组相关的结局，我们进行了Cox回归分析以确定混杂的合并症。术前人口统计学特征和合并症相似。BMI > 30的患者更年轻（P = 0.01），2型糖尿病发病率更高（P = 0.01）。虽然BMI > 30的患者泵血栓形成率更高（P = 0.02），但2年总体生存率无差异。肥胖组最常见的死亡原因是出血性卒中。多变量Cox回归分析显示，BMI是泵血栓形成的独立危险因素。
较高的BMI不会降低VAD植入后的生存率，但似乎会增加泵血栓形成的风险。有必要进一步研究以明确BMI在生存率和血栓形成率中的作用。
