The Impact of Obesity on Durable Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis.

BACKGROUND

Obesity and advanced heart failure (HF) increasingly intersect in clinical practice, yet their combined influence on outcomes following durable left ventricular assist device (LVAD) implantation remains uncertain.

METHODS

We conducted a systematic review and meta-analysis in accordance with PRISMA 2020, searching six databases to June 2025. Twenty-six cohort studies encompassing 14 100 adults (4982 obese; 9118 non-obese) met inclusion criteria. Pooled odds ratios (ORs) and risk ratios (RRs) were generated using random-effects models for mortality and adverse events.

RESULTS

Obese LVAD recipients were younger, more often female, and had higher prevalences of diabetes, hypertension, and sleep apnea than non-obese patients. Short-term mortality did not differ significantly between groups (OR 0.80, 95% CI 0.59-1.08). Similarly, follow-up mortality at ≥ 1 year showed no significant difference, although obese patients tended to have lower risk (RR 0.81, 95% CI 0.56-1.17). In contrast, obesity was associated with a distinct complication profile: higher risks of device-related infection (RR 1.48, 95% CI 1.26-1.75), pump thrombosis/device malfunction (OR 1.57, 95% CI 1.37-1.81), and right heart failure (RR 1.23, 95% CI 1.08-1.39). Rates of stroke, arrhythmia, respiratory failure, and major bleeding did not differ significantly between obese and non-obese patients.

CONCLUSIONS

Obesity does not confer excess short-term or long-term mortality after durable LVAD implantation but is associated with substantially higher risks of infection, pump thrombosis, and right heart failure. These findings suggest that obesity alone should not preclude LVAD candidacy, while underscoring the need to recognize and manage the increased morbidity burden in this population and to further investigate outcomes in contemporary, device-specific cohorts.