The goal of this clinical trial is to assess whether a peri-operative intervention with nutritional immune modulating intervention (Ensure Surgery Immunonutrition shake) has beneficial effects on the complex interplay between gut microbiome, systemic inflammation and malnutrition that is commonly present in advanced heart failure and the adverse events associated with left ventricular assist device (LVAD) placement in hospitalized advanced heart failure patients awaiting LVAD implantation. The main questions it aims to answer are: * Will pre-surgical supplementation with Ensure Surgery affect gut microbial composition and levels of inflammation among heart failure patients undergoing LVAD implantation? * Will pre-surgical supplementation with Ensure Surgery affect post-surgical morbidity (e.g., infections, intensive care unit length of stay (LOS)) and mortality? Participants will be evaluated for malnutrition and will be given Ensure Surgery Immunonutrition shake to drink in the days preceding their LVAD surgery. Blood and stool samples will be collected at prespecified timepoints before and after surgery. Researchers will compare malnourished participants drinking Ensure Surgery 3/day with well-nourished participants randomized to drink either 1/day or 3/day to see if any of the above supplementation strategies change the gut microbial composition, levels of inflammation, and post-surgical morbidity and mortality.
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Change in Alpha Diversity (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in Alpha Diversity (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in Alpha Diversity (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in Alpha Diversity (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in Microbial Gene Count (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in Microbial Gene Count (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in Microbial Gene Count (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in Microbial Gene Count (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in C-Reactive Protein (CRP) (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in C-Reactive Protein (CRP) (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in C-Reactive Protein (CRP) (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in C-Reactive Protein (CRP) (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in N-terminal (NT)-pro hormone BNP (NT-proBNP) (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in N-terminal (NT)-pro hormone BNP (NT-proBNP) (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in N-terminal (NT)-pro hormone BNP (NT-proBNP) (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in N-terminal (NT)-pro hormone BNP (NT-proBNP) (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in lipopolysaccharide (LPS) (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in lipopolysaccharide (LPS) (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in lipopolysaccharide (LPS) (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in lipopolysaccharide (LPS) (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in Tumor Necrosis Factor (TNF) (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in Tumor Necrosis Factor (TNF) (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in Tumor Necrosis Factor (TNF) (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in Tumor Necrosis Factor (TNF) (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in Interleukin 6 (IL-6) (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in Interleukin 6 (IL-6) (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in Interleukin 6 (IL-6) (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in Interleukin 6 (IL-6) (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in Interleukin 10 (IL-10) (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in Interleukin 10 (IL-10) (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in Interleukin 10 (IL-10) (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in Interleukin 10 (IL-10) (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)
Change in Short-Chain Fatty Acids (Baseline and Day 5)
Timeframe: Baseline and Day 5
Change in Short-Chain Fatty Acids (Baseline and Pre-VAD)
Timeframe: Baseline and Pre-VAD (approximately Day 0-5)
Change in Short-Chain Fatty Acids (Baseline and Discharge)
Timeframe: Baseline and Discharge (approximately Day 25)
Change in Short-Chain Fatty Acids (Baseline and Post-Discharge Follow-up)
Timeframe: Baseline and Post-Discharge Follow-up (approximately Day 55)