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Background Left ventricular assist device (LVAD) candidates commonly experience unintentional weight loss (cardiac cachexia) pre-implantation. Cardiac cachexia is associated with mortality, but patients may regain lost weight once supported by an LVAD. We sought to characterize early post-LVAD weight changes, define the impact of early weight gain on survival, and identify pre-LVAD biomarkers of subsequent weight gain failure. Methods We reviewed single-center durable LVAD recipients 2010-2015, recording percent weight change (WC) from implantation to 3 and 6 months of LVAD support (±14 days). We constructed a Cox model, starting at 3 months, for the relationship between WC and mortality on LVAD support (censored on transplant). We used linear regression to identify pre-LVAD laboratory variables associated with positive WC at 3 months post-LVAD. Results Of 211 LVAD recipients, 166 survived on LVAD support >3 months and were eligible for analysis (21% female, mean age 55 y, BMI 27.9 kg/m 2 ). Pre-LVAD BMI was not associated with subsequent mortality. The mean WC at 3 and 6 months was -2.97% (±std dev 8.66%) and +1.69% (±10.72%), respectively ( Figure 1a ), with 23% and 47% of patients achieving ≥+3% WC at 3 and 6 months. Patients with pre-LVAD BMI 2 were more likely to gain ≥+3% weight than those with pre-LVAD BMI ≥25 kg/m 2 at 3 months (44% vs 11%, p Figure 1b ). Positive WC at 6 months showed a similar association: adjusted HR 0.92, 95% CI 0.88-0.96, p Conclusion Mean weight declines early post-LVAD, followed by subsequent weight recovery at 6 months of LVAD support. A positive WC at 3 or 6 months is associated with greater future survival. Low albumin and high NLR at LVAD implantation may identify recipients at risk of weight gain failure, who could be targeted for an early nutritional intervention.

predicts length of stay, 14.6% of the variability in LOS was attributed to preoperative nutrition and inotropes, (R50.14; p!.001) The nutritional coefficient was -0.288 (p-value 5 0.001) and inotrope use coefficient was 0.246 (p-value 5 0.013) (Fig. A). There was a trend towards higher costs for patients with a serum albumin !3g/dL (HR .85; p!.07). Patients on inotropes had a 38% higher admission cost (HR 1.38; p!.001). Patients on inotropes with a serum albumin greater than 3g/dL had 22% (HR .78; p!.024) lower admission costs than those who were malnourished. The addition of inotropes to a malnourished patient had 54% higher admission costs (HR 1.54; p!.001). In contrast, patient’s receiving MCS with normal serum albumin and the addition of inotropes did not significantly add to costs (HR 1.25; p!.068). Conclusion: We identified a novel finding in patients undergoing durable MCS. Cardiac cachexia compounded the length of stay in the heart failure population receiving mechanical circulatory support. We suggest a thorough nutritional assessment prior to MCS placement. Nutritional status may assist surgeons and cardiologist in choosing the optimal timing of intervention to shorten LOS and resource utilization.