Value of Nutritional Indices in Predicting Survival Free from Pump Replacement and Driveline Infections in Centrifugal Left Ventricular Assist Devices

Objective There is a paucity of data assessing the impact of nutritional status on outcomes in patients supported with the Heartmate 3 (HM3) left ventricular assist device (LVAD). Methods Patients ≥18 years of age who underwent HM3 LVAD implantation between 2015 and 2020 were identified from a single tertiary care center. The primary outcome assessed was death or device replacement. A secondary outcome of driveline infection was also evaluated. Kaplan-Meier survival analysis and a multivariate Cox-Proportional Hazards model were used to identify predictors of outcome. Results Of the 289 patients identified, 94 (33%) experienced a primary outcome and 96 (33%) a secondary outcome during a median follow-up time of 2.3 years. Independent predictors of the primary outcome included peripheral vascular disease (HR 3.40, 95% CI 1.66-6.97, p<0.01), diabetes mellitus (HR 0.46, 95% CI 0.27-0.80, p<0.01), BMI≥40 kg/m2 (HR 2.63 per 1 kg/m2 increase, 95% CI 1.22-5.70, p<0.05), pre-operative creatinine level (HR 1.86 per 1 mg/dL increase, 95% CI 1.31-2.65, p<0.01) and pre-operative prognostic nutritional index (PNI) score (HR 0.88 per 1 point increase, 95% CI 0.81-0.96, p<0.01). Independent predictors of driveline infection included age at the time of implantation (HR 0.97, 95% CI 0.96-0.99, p<0.01) and diabetes mellitus (HR 1.79, 95% CI 1.17-2.73, p<0.01). Conclusions Pre-operative PNI scores may independently predict mortality and the need for device replacement in patients with HM3 LVAD. Routine utilization of the PNI score during pre-operative evaluation and, when possible, supplementation to PNI>33, may be of value in this population.