Correlation between obesity and increased postoperative complication risk in endstage heart failure patients who underwent ventricular assist device implantation
Öz
Aim: Evaluation of the correlation between obesity and
postoperative complication risk in end-stage heart failure (ESHF) patients who underwent
ventricular assist device (VAD) implantation.
Materials and Methods: The charts of 373
ESHF patients underwent continuous-flow VAD implantation were reviewed
retrospectively. One hundred-sixty-seven cases with minimum three months of
postoperative follow-up were enrolled. Demographics and implanted VAD type,
body mass index (BMI) and body surface area (BSA) that measured at the last
follow-up visit as well as the presence of major postoperative complications
including wound infection (WI), pump thrombosis (PT), gastrointestinal bleeding
(GIB), and cerebrovascular event (CVE) were noted for each participant.
Prevalence of the evaluated complications were statistically compared with both
BMI and BSA scores.
Results: Of the 167 cases with a mean age of 53.3±13.1 (12-74)
years, 20 (12%) were females. Implanted VAD type was HeartWare in 117 cases
(70.1%), HeartMate-2 in 24 cases (14.4%), and HeartMate-3 in 26 cases (15.6%).
Mean follow-up, BMI and BSA scores were 26.1±18.2 months, 27.7±4.3 and 1.97±0.20
m2, respectively. Prevalence of WI, PT, GIB, and CVE were 22.8%,
21.0%, 15.0%, and 15.6%, respectively. Increased PT and GIB risks were found in
cases with higher BMI (p=0.047 and p=0.018, respectively); and GIB risk was
higher in subjects with greater BSA (p=0.016). Obese patients had also higher
risk for the development of both GIB and CVE (p=0.012 and p=0.040,
respectively).
Conclusion: Obesity; which is a well-known risk factor for
mortality in heart transplantation, may also be a predictive factor in deciding
the optimal candidates for VAD implantation.
Anahtar Kelimeler
Body mass index obesity postoperative complication ventricular assist device.
Kaynakça
- Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end stage heart failure. N Engl J Med 2001; 345 (20): 1435-43.
- Fukunaga N, Rao V. Left ventricular assist device as destination therapy for end stage heart failure: The right time for the right patients. Curr Opin Cardiol 2018; 33 (2): 196-201.
- Guha A, Nguyen D, Cruz-Solbes AS, et al. Risk stratification of patients with current generation continuous-flow left ventricular assist devices being bridged to heart transplantation. ASAIO J 2018; 64 (2): 196-202.
- Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med 1993; 119 (7 Pt 2): 655-60.
- Grady KL, Costanzo MR, Fischer S, Koch D. Preoperative obesity is associated with decreased survival after heart transplantation. J Heart Lung Transplant 1996; 15 (9): 863-71.
- Filardo G, Pollock BD, Edgerton J. Categorizing body mass index biases assessment of the association with post-coronary artery bypass graft mortality. Eur J Cardiothorac Surg 2017; 52 (5): 924-9.
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obes Res 1998; 6 (Suppl 2): 51S-209S.
- Brewer RJ, Lanfear DE, Sai-Sudhakar CB, et al. Extremes of body mass index do not impact mid-term survival after continuous-flow left ventricular assist device implantation. J Heart Lung Transplant 2012; 31 (2): 167-72.
- Go PH, Nemeh HW, Borgi J, Paone G, Morgan JA. Effect of body mass index on outcomes in left ventricular assist device recipients. J Card Surg 2016; 31 (4): 242-7.
- Musci M, Loforte A, Potapov EV, et al. Body mass index and outcome after ventricular assist device placement. Ann Thorac Surg 2008; 86 (4): 1236-42.
- Raymond AL, Kfoury AG, Bishop CJ, et al. Obesity and left ventricular assist device driveline exit site infection. ASAIO J 2010; 56 (1): 57-60.
- Clerkin KJ, Naka Y, Mancini DM, Colombo PC, Topkara VK. The Impact of obesity on patients bridged to transplantation with continuous-flow left ventricular assist devices. JACC Heart Fail 2016;4(10):761-8.
- Han JJ, Sooppan R, Johnson AP, et al. Higher body mass index increases risk of HeartMate II pump thrombosis but does not adversely affect long-term survival. Circ J 2017; 81 (2): 213-9.
- Boyle AJ, Jorde UP, Sun B, et al. Pre-operative risk factors of bleeding and stroke during left ventricular assist device support: An analysis of more than 900 HeartMate II outpatients. J Am Coll Cardiol 2014; 63 (9): 880-8.
- 15. Balcioglu O, Kemal HS, Ertugay S, et al. Risk Factors of Gastrointestinal Bleeding After Continuous Flow Left Ventricular Assist Device. ASAIO J 2017 Sep 27. doi: 10.1097/MAT.0000000000000678. [Epub ahead of print]
- Volkovicher N, Kurihara C, Critsinelis A, et al. Effect of obesity on outcomes in patients undergoing implantation of continuous-flow left ventricular assist devices. J Artif Organs 2018 Jan 25. doi: 10.1007/s10047-017-1013-2. [Epub ahead of print].
Ventriküler destek cihazı takılan son dönem kalp yetmezliği hastalarında obezite ile artmış postoperatif komplikasyon gelişim riskinin ilişkisi
Öz
Amaç:
Ventriküler
destek cihazı (VDC) uygulanan son dönem kalp yetmezliği (SDKY) olgularında obezite
ile postoperatif komplikasyon sıklığı ilişkisinin incelenmesi.
Gereç
ve Yöntem: Kliniğimizde
SDKY tanısı ile devamlı akım sağlayan VDC implantasyonu uygulanan 373 hastanın
kayıtları retrospektif olarak taranmıştır. Çalışmaya taranan komplikasyonlara
yatkınlık yaratacak kontrolsüz metabolik hastalığı bulunmayan ve en az üç ay
süreli takibi olan 167 olgu dahil edilmiştir. Demografik özelliklerin yanında
uygulanan VDC tipi, son kontroldeki vücut kitle indeksi (VKİ), vücut yüzey
alanı (VYA) değerleri ile postoperatif major komplikasyonlardan yara yeri
enfeksiyonu, pompa trombozu, gastrointestinal sistem (GİS) kanaması ve
serebrovasküler olay (SVO) gelişimleri her olgu için kayıtlanmıştır. Hastaların
VKİ ve VYA değerleri ile taranan komplikasyonların görülme sıklıkları
istatistiksel olarak karşılaştırılmıştır.
Bulgular:
Yirmisi
(%12) kadın, toplam 167 olgunun yaş ortalaması 53.3±13.1 (12–74) yıldı.
Olguların 91’inde (%54.5) dilate, geri kalanlarda ise iskemik kardiyomiyopati
tanısı mevcut olup, 117’sinde (%70.1) HeartWare, 24’ünde (%14.4) HeartMate-2 ve
26’sında (%15.6) HeartMate-3 cihazı implante edilmiştir. Postoperatif ortalama
26.1±18.2 aydaki son kontrolde ölçülen VKİ ve VYA ortalaması 27.7±4.3 ve
1.97±0.20 m2 idi. Tüm grupta yara yeri enfeksiyonu, pompa trombozu,
GİS kanaması ve SVO sıklıkları sırasıyla %22.8, %21.0, %15.0 ve %15.6 olarak
bulundu. Daha yüksek VKİ’li olgularda pompa trombozu ve GİS kanaması görülme
sıklığının arttığı (p=0.047 ve p=0.018), daha yüksek VYA olgularında da GİS
kanaması görülme riskinin yükseldiği saptandı (p=0.016). Ayrıca obezlerde GİS
kanaması ve SVO riskinin yüksek olduğu bulundu (p=0.012 ve p=0.040).
Sonuç:
Kalp
naklinde mortalite için ciddi risk faktörü olduğu bilinen obezite,
transplantasyona köprüleme amaçlı VDC implantasyonu kararında da hasta
seçiminde dikkat edilmesi gereken bir durumdur.
Anahtar Kelimeler
Obezite postoperatif komplikasyon ventriküler destek cihazı vücut kitle indeksi
Kaynakça
- Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end stage heart failure. N Engl J Med 2001; 345 (20): 1435-43.
- Fukunaga N, Rao V. Left ventricular assist device as destination therapy for end stage heart failure: The right time for the right patients. Curr Opin Cardiol 2018; 33 (2): 196-201.
- Guha A, Nguyen D, Cruz-Solbes AS, et al. Risk stratification of patients with current generation continuous-flow left ventricular assist devices being bridged to heart transplantation. ASAIO J 2018; 64 (2): 196-202.
- Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med 1993; 119 (7 Pt 2): 655-60.
- Grady KL, Costanzo MR, Fischer S, Koch D. Preoperative obesity is associated with decreased survival after heart transplantation. J Heart Lung Transplant 1996; 15 (9): 863-71.
- Filardo G, Pollock BD, Edgerton J. Categorizing body mass index biases assessment of the association with post-coronary artery bypass graft mortality. Eur J Cardiothorac Surg 2017; 52 (5): 924-9.
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obes Res 1998; 6 (Suppl 2): 51S-209S.
- Brewer RJ, Lanfear DE, Sai-Sudhakar CB, et al. Extremes of body mass index do not impact mid-term survival after continuous-flow left ventricular assist device implantation. J Heart Lung Transplant 2012; 31 (2): 167-72.
- Go PH, Nemeh HW, Borgi J, Paone G, Morgan JA. Effect of body mass index on outcomes in left ventricular assist device recipients. J Card Surg 2016; 31 (4): 242-7.
- Musci M, Loforte A, Potapov EV, et al. Body mass index and outcome after ventricular assist device placement. Ann Thorac Surg 2008; 86 (4): 1236-42.
- Raymond AL, Kfoury AG, Bishop CJ, et al. Obesity and left ventricular assist device driveline exit site infection. ASAIO J 2010; 56 (1): 57-60.
- Clerkin KJ, Naka Y, Mancini DM, Colombo PC, Topkara VK. The Impact of obesity on patients bridged to transplantation with continuous-flow left ventricular assist devices. JACC Heart Fail 2016;4(10):761-8.
- Han JJ, Sooppan R, Johnson AP, et al. Higher body mass index increases risk of HeartMate II pump thrombosis but does not adversely affect long-term survival. Circ J 2017; 81 (2): 213-9.
- Boyle AJ, Jorde UP, Sun B, et al. Pre-operative risk factors of bleeding and stroke during left ventricular assist device support: An analysis of more than 900 HeartMate II outpatients. J Am Coll Cardiol 2014; 63 (9): 880-8.
- 15. Balcioglu O, Kemal HS, Ertugay S, et al. Risk Factors of Gastrointestinal Bleeding After Continuous Flow Left Ventricular Assist Device. ASAIO J 2017 Sep 27. doi: 10.1097/MAT.0000000000000678. [Epub ahead of print]
- Volkovicher N, Kurihara C, Critsinelis A, et al. Effect of obesity on outcomes in patients undergoing implantation of continuous-flow left ventricular assist devices. J Artif Organs 2018 Jan 25. doi: 10.1007/s10047-017-1013-2. [Epub ahead of print].
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 25 Mart 2018 |
| Yayımlandığı Sayı | Yıl 2019 |