Unintentional 1-Year BMI Decrease After HeartMate 3 Implantation is Associated with Higher Early Morbidity

BACKGROUND: Weight loss after HeartMate 3 (HM3) implantation is desired to decrease the risk of adverse events in obese patients. The implications of longitudinal body mass index (BMI) fluctuations and visceral protein (albumin, prealbumin) kinetics following HM3 implantation remain poorly characterized. We aimed to investigate the association of 1-year BMI, albumin, and prealbumin trends with clinical outcomes to differentiate healthy metabolic improvement from pathological failure to thrive after HM3 implantation. METHODS: This retrospective cohort study included 168 patients who underwent HM3 implantation at a large academic center between May 2015 and July 2020 and survived for at least 12 months. Patients were stratified by 12-month BMI changes: BMI-Gain (>10% increase), BMI-Similar (<10% change), and BMI-Loss (>10% decrease). Serial BMI, albumin, and prealbumin levels were analyzed for 12 months alongside postoperative adverse events and survival. RESULTS: At 12 months post-implantation, 58 patients (34.5%) had BMI-Gain, 94 (56.0%) were BMI-Similar, and 16 (10.1%) experienced BMI-Loss. The BMI-Loss cohort exhibited a more profound 1-month nadir in both prealbumin and albumin. BMI-Loss was associated with early morbidity, including longer ICU stay (11.5 vs. 7 days; p=0.027), higher rates of percutaneous endoscopic gastrostomy tube placement (12.5% vs. 1.7%; p=0.010), and a trend toward increased mortality beyond 1 year (p=0.058). A subgroup of obese patients who successfully achieved a BMI <35 kg/m² had severe early hypoalbuminemia and clinical decompensation rather than physiological optimization. CONCLUSION: Unintentional weight loss 1-year post-HM3 implantation is uncommon, and these patients tended to have higher early morbidity, lower nadirs of albumin and prealbumin early post-HM3 implantation, and a trend towards higher mortality after 1 year.