Heart failure (HF) has an estimated prevalence of >37.7 million individuals globally. In
the US alone, which is projected to increase by 46% between the years 2012 and 2030.
Despite significant advances in HF medical and device therapies, patient prognosis after
their first HF hospital admission is poor, with a <50% survival rate at five years and
significant proportion of patients progressing from chronic stable disease to advanced HF
state. Once advanced HF ensues, LVADs are one of the two main treatment modalities that
can meaningfully improve survival in this patient population.
Chronic systemic inflammation is commonly observed in HF and is believed to be directly
related to its pathogenesis. Recently, perturbations in the gut microbiota known as "gut
dysbiosis" and impairment of gut mucosal barriers, facilitating entry of endotoxins and
gut metabolites into the circulation, have also been observed in HF patients. Elevated
levels of circulating endotoxins and bacterial bi-products enhance systemic inflammation,
thereby contributing to progression of HF to more advanced disease state. Gut microbial
perturbations may also alter enterocyte structure and function resulting in
gastrointestinal dysmotility, nutrient malabsorption and eventually malnutrition.
Malnutrition is frequent in HF (as high as 62%), is associated with higher rates of
mortality, hospital readmissions and an increased risk of adverse early postoperative
outcomes. Infections are the most common complications following LVAD, affecting >50% of
HF patients, contributing significantly to postoperative mortality, increased length-of
stay (LOS) and hospital readmissions. The pre-operative period may represent an
attractive time window in which to optimize HF patients, correct deficiencies, and
enhance immune defense mechanisms before surgery. This period allows to act upon
modifiable risk factors, such as the nutritional status, and potentially lower the risk
of postoperative complications. However, the literature on perioperative optimization in
HF comes mainly from anesthesiology and focuses on intra- and immediate postoperative
management, when it may be too late to intervene and alter the outcome. Interestingly,
guidelines on the nutritional evaluation and management of patients prior to non-cardiac
surgery are available, but very limited literature is published concerning cardiac
surgery, and no data exists with respect to LVAD surgery. The investigators plan to
evaluation of the impact of preoperative nutrition intervention.