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Impact of hepatic steatosis on outcomes after left ventricular assist device implantation
Yeahwa Hong1, Keith Dufendach2, Yisi Wang3
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Preoperative hepatic steatosis (fatty liver disease) does not worsen outcomes after left ventricular assist device (LVAD) implantation. This finding suggests hepatic steatosis has a limited role in selecting or predicting patient prognosis for LVAD surgery.
Area of Science:
- Cardiology
- Transplant Surgery
- Radiology
Background:
- Hepatic steatosis, or fatty liver disease, is increasingly prevalent.
- Its impact on outcomes following left ventricular assist device (LVAD) implantation is not well-defined.
- This study investigates the association between hepatic steatosis and LVAD outcomes.
Purpose of the Study:
- To evaluate the effect of preoperative hepatic steatosis on survival and adverse events after continuous-flow LVAD implantation.
- To determine if radiographic evidence of hepatic steatosis influences patient selection or prognosis.
Main Methods:
- Retrospective analysis of 203 adult patients who underwent LVAD implantation (2004-2018).
- Preoperative computed tomography scans were used to identify radiographic signs of hepatic steatosis.
- Patients were stratified based on the presence or absence of hepatic steatosis.
Main Results:
- 27.6% of patients had radiographic hepatic steatosis, associated with higher BMI, MELD-XI scores, and diabetes incidence.
- Rates of postimplant adverse events (bleeding, infection, renal failure, etc.) were similar between groups.
- Unadjusted and risk-adjusted survival were comparable, with no significant impact of hepatic steatosis on mortality.
Conclusions:
- Preoperative hepatic steatosis identified on imaging does not predict increased morbidity or mortality after LVAD implantation.
- Despite associations with obesity and metabolic diseases, hepatic steatosis has a limited role in LVAD patient prognostication.
- Findings support the continued use of LVADs in appropriate heart failure patients, irrespective of imaging-detected hepatic steatosis.
Background:
This single-center, retrospective study evaluates the impact of hepatic steatosis on outcomes after continuous-flow left ventricular assist device (LVAD) implantation.
Methods:
Adults undergoing LVAD implantation between 2004 and 2018 with a preoperative noncontrast-enhanced chest and abdominal computed tomography scan were included in the study. Patients were stratified as with and without radiographic signs of hepatic steatosis. The primary outcome was survival, and secondary outcomes included rates of postimplant adverse events.
Results:
A total of 203 patients were included in the study. 27.6% (n = 56) had radiographic signs of hepatic steatosis. Hepatic steatosis group had a higher body mass index (30.1 vs. 27.0, p < .01), model for end-stage liver disease excluding international normalized ratio score (16.8 vs. 15.1, p = .05), and incidence of diabetes (53.6% vs. 35.4%, p = .02). The rates of postimplant adverse events, including bleeding, infection, reoperation, renal failure, hepatic dysfunction, stroke, and right ventricular failure, were similar between the groups (all, p > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, 1-year, and 2-year following LVAD implantation (all, p > .05). In addition, hepatic steatosis did not impact risk-adjusted overall mortality when modeled as a categorical variable (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.46-1.13; p = .15).
Conclusions:
This study demonstrates that the presence of preoperative hepatic steatosis on imaging is not predictive of increased morbidity or mortality following LVAD implantation. Despite the association with obesity, metabolic diseases, and heart failure, hepatic steatosis on imaging appears to have a limited role in patient selection or prognostication in LVAD patients.
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