Psoas Muscle Index Predicts Perioperative Mortality in Patients Undergoing LVAD Implantation

Background: Sarcopenia is associated with adverse surgical outcomes across multiple specialties. The psoas muscle index (PMI), a radiologic marker of sarcopenia, may offer prognostic value in patients undergoing left ventricular assist device (LVAD) implantation, a population frequently characterized by frailty and high perioperative risk. Methods: We conducted a single-center retrospective study of 32 patients who underwent LVAD implantation between 2017 and 2022 and had preoperative CT imaging within 45 days. PMI was calculated from bilateral psoas muscle area at the L3 vertebral level, normalized to height. Sarcopenia was defined as the lowest sex-specific quartile of PMI. Primary outcomes were overall survival (OS), 90-day mortality, and postoperative length of stay (LOS). Results: Eight patients (25%) met criteria for sarcopenia. Sarcopenic and non-sarcopenic groups had similar demographics, comorbidities, and nutritional status. While there were no significant differences in overall, 90-day, or 1-year mortality between groups, among those who died post-implantation, the sarcopenic group had significantly shorter OS (median 38 vs. 597 days, p = 0.006). All sarcopenic deaths occurred within 90 days post-implant. LOS did not differ significantly between groups. Conclusions: PMI-defined sarcopenia was associated with early postoperative mortality among LVAD recipients, though not with overall or long-term mortality.