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Left ventricular assist device (LVAD) studies find similar outcomes in obese patients and between two leading devices

OCTOBER 24, 2017
Clinical Congress Daily Highlights, Tuesday First Edition

Two studies presented Tuesday found that two leading left ventricular assist devices (LVAD) have similar outcomes at six and 24 months, and that obesity is not a contraindication to continous flow implantation of these devices.

The comparison study was motivated by suggestions of increased stroke risk for advanced cardiomyopathy patients receiving the Heartware HVAD compared with the Heartmate 2, as seen in the ENDURANCE destination therapy (DT) trial.

A two-year retrospective review led by Nicholas Clarke, MD, of the UT Southwestern Medical Center, Dallas, TX, found no difference between the devices in two-year LVAD-supported survival, stroke-free survival, and composite endpoints at six and 24 months. Pump thrombus was more common in the Heartmate group,  while postoperative right ventricular dysfunction was more common in the Heartware group (p < 0.01).

The study covered all 187 end-stage heart failure patients who received one of the two devices as bridge to transplantation or destination therapy at UT Southwestern between January 2010 and June 2016. A total of 133 patients (71 percent) received the Heartmate II and 54 patients (29 percent) the Heartware.

In the obesity study, researchers analyzed the impact of body mass index (BMI) on outcomes in patients undergoing continuous-flow LVAD implantation. Obesity is a known risk factor following heart transplantation, but no such consensus exists for LVAD implantation patients.

The single-institution study led by Masashi Kawabori at Texas Heart Institute, Baylor College of Medicine, Houston, TX, found no survival difference for appropriately selected obese patients undergoing CF-LVAD implantation. Obesity should not be a contraindication to CF-LVAD implantation, the researchers concluded.

The study examined records of 526 patients with chronic heart failure who underwent primary CF-LVAD with either the HeartMate II or HeartWare devices from January 1999 through March 2016. Patients were stratified into underweight, normal, overweight, and obese groups based on BMI. Records were reviewed to determine postoperative complications and survival. The obese group had higher diabetes and hypertension compared with patients in the normal cohort.

Additional Information:

These two Scientific Forum studies on left ventricular assist devices were presented October 24 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA.  Program, webcast and audio information is available online at FACS.org/clincon2017. View the full abstracts here: Abstract 1, Abstract 2.

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