Trends in body mass index and association with outcomes in pediatric patients on continuous flow ventricular assist device support

Authors: PURI, KRITI - Baylor College Of Medicine; ADACHI, IKI - Baylor College Of Medicine; BOCCHINI, CLAIRE - Baylor College Of Medicine; SPINNER, JOSEPH - Baylor College Of Medicine; DENFIELD, SUSAN - Baylor College Of Medicine; SISLEY, STEPHANIE - Children'S Nutrition Research Center (CNRC); ELIAS, BARBARA - Baylor College Of Medicine; JIMENEZ-GOMEZ, ANDRES - Baylor College Of Medicine; PRICE, JACK - Baylor College Of Medicine; DREYER, WILLIAM - Baylor College Of Medicine; CHOUDHRY, SWATI - Baylor College Of Medicine; TUNUGUNTLA, HARI - Baylor College Of Medicine

Submitted to: Transactions of the American Society of Artificial Internal Organs
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/20/2021
Publication Date: 12/28/2021
Citation: Puri, K., Adachi, I., Bocchini, C., Spinner, J., Denfield, S., Sisley, S., Elias, B., Jimenez-Gomez, A., Price, J., Dreyer, W., Choudhry, S., Tunuguntla, H. 2021. Trends in body mass index and association with outcomes in pediatric patients on continuous flow ventricular assist device support. ASAIO Journal. https://doi.org/10.1097/MAT.0000000000001633.
DOI: https://doi.org/10.1097/MAT.0000000000001633

Interpretive Summary: Some children with heart disease need a ventricular assist device (VAD) to help their heart function. The development of obesity in children can significantly complicate health, including outcomes related to heart function and blood pressure. Limited data exists regarding how a child's weight status may impact outcomes of VAD implantation and outcomes. We compared all children who received a continuous-flow VAD for more than 30 days over an eleven year time period. We classified them based on their body mass index (BMI) criteria at the time of surgery into underweight, healthy weight, overweight, and obese categories. We found that BMI increased across all categories during VAD support, with 29% of the patients increasing their BMI category. No obese subjects reduced their BMI category. There was no significant difference in hospital morality, postoperative length of stay, or pump clotting in the VAD device. Subjects who had an overweight status had more frequent non-VAD infections. Obese individuals required longer duration on VAD support and were less likely to receive a heart transplant. Our research shows that pediatric patients on VAD support who are overweight or obese have significant increases in their BMI and those with obesity are less likely to receive a heart transplant. This suggests that weight gain during VAD treatment may be detrimental to a patients ultimate health outcomes. The study provides some fundamental insight into the impacts of heart disease and the impact of being overweight in a pediatric population.

Technical Abstract: Data are limited regarding body mass index (BMI) in pediatric patients supported by ventricular assist devices (VAD) and associated clinical outcomes and complications. We performed a retrospective single-center cohort study including patients aged =21 years on durable continuous-flow VAD support for =30 days from 2009 to 2020. Patients were classified based on BMI percentile at implant using the US Centers for Disease Control and Prevention criteria: underweight (<5th percentile), healthy weight (5th-<85th percentile, reference group), overweight (85th-<95th percentile), and obese (=95th percentile). Primary outcomes were hospital mortality and length of stay (LOS) after implant. Secondary outcomes included infectious complications and pump thrombosis. Seventy-two patients (58 HeartWare, 13 HeartMateII, 1 HeartMate3) were included. At implant, the study cohort comprised 13% underweight, 53% healthy weight, 18% overweight, and 17% obese. BMI increased across all categories during support, with 29% gaining BMI categories. No patients with obesity reduced their BMI category. At explant, the study cohort comprised 1% underweight, 54% healthy weight, 22% overweight, and 22% obese. There was no significant difference in hospital mortality, postoperative LOS, or pump thrombosis. Patients who were overweight had more frequent non-VAD infections. Patients with obesity required longer duration on VAD support and were less likely to be transplanted. We concluded that pediatric patients on VAD support who are overweight or have obesity do not improve their BMI and instead have significant increase. Larger studies are needed to assess the impact of abnormal BMI on VAD complications in pediatric patients.