Complete Sternal-Sparing LVAD Implantation is a Safe and Effective Technique for Obese Patients

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S80
• Main Authors: Wood, K., Ayers, B.C., Vidula, H., Alexis, J., Barrus, B., Prasad, S., Gosev, I.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.184

Obese patients supported by continuous flow left ventricular assist devices (LVADs) have comparable outcomes to those with a normal BMI. However, cardiac surgery in obese patients is associated with increased procedural complexity and morbidity. We describe our early outcomes using the complete sternal-sparing (CSS) approach for HeartMate 3 (HM3) implantation in obese patients.
We retrospectively reviewed all commercial HM3 implants at our institution through September 2018. Patients were separated into two groups based on BMI <30 (non-obese) and BMI ≥ 30 (obese). Baseline characteristics, intraoperative data, early clinical outcomes, and 30-day survival were compared between groups.
Of the 41 patients who underwent complete sternal sparing HM3 implantation, 18 (44%) were obese. The non-obese cohort had an average BMI of 24.8 ±2.8 compared to the obese cohort average BMI of 37.2 ±5.9. Six patients (15%) were extremely obese (BMI >40) (Figure). Preoperative characteristics and illness severity were similar between patient cohorts including > 39% of INTERMACS 1 patients in each group (Table). There was no significant difference in intraoperative data or early clinical outcomes. Both obese and non-obese patients demonstrated similar intensive care unit and hospital lengths of stay. There was no difference in 30-day survival or 30-day readmission rate.
The CSS approach is a safe and effective technique for LVAD implantation in obese patients. There is no increased risk of morbidity or mortality between obese and non-obese patients implanted with the HM3 LVAD using the CSS approach.