Abstract 3660: Insertion of Left Ventricular Assist Devices as a ‘Bridge to Weight Loss’ Prior to Listing for Transplantation in Obese Patients With Advanced Heart Failure
Background. Morbid obesity is considered a risk factor for heart failure (HF), but is also associated with poor outcomes after cardiac transplantation (Tx) and therefore, is regarded a relative contra-indication. Achieving adequate weight loss appears difficult among patients (pts) who are unable to exercise due to de-conditioning and reduced cardiac capacity. We assessed weight loss in HF pts after implantation of left ventricular assist devices (LVAD) compared to medical management.
Methods. Nineteen obese pts (9 females, age 51.3±10.0 yrs) with advanced HF (NYHA class III–IV, stage D) were evaluated for Tx. Thirteen pts (grp 1) received surgical insertion of LVAD (Heartmate XVE™, Thoratec, Pleasanton, CA) as bridge to Tx. The remaining six pts (grp 2) were medically managed. All pts were advised on dietary and lifestyle modification. Pts were followed for 12 months; clinical status and weight loss were evaluated.
Results. All pts were alive at follow-up. Pts in grp 1 (6 females, age 49.1±10.7 yrs) had a body weight (BW) of 246.6±34.9 lbs (mean±SD) and a BMI of 36.1±4 at baseline. Pts in grp 2 (3 females, 56±6.7 yrs) had a BW of 238.8±73.6 lbs and a BMI of 39.1±9.3 at baseline (not significant (n.s.) vs grp 1). At 6 months, BW was 216.3±20.8 lbs, BMI was 31.8±3.3 in grp 1(p<0.05 vs baseline); in grp 2, BW was 238.2±84.6 lbs, BMI was 39.1±11.6 (n.s. vs baseline, p<0.05 vs grp 1). Pts in grp 1 lost 12.3±12% BW (30.3±28.5 lbs), pts in grp 2 lost 0.3±8.7% BW (0.6±21 lbs, p<0.05 vs grp 1). At 12 months, 7/13 pts in grp 1 (54%) underwent successful Tx while none of the pts in grp 2 (0%) were listed for Tx because of persistent obesity.
Conclusion. LVAD insertion using Heartmate XVE™ resulted in significant weight loss in obese pts considered for heart transplantation compared to medically managed patients. We hypothesize that weight loss was achieved by
improved physical conditioning, with increased calorie expenditure, as a result of increased cardiac capacity and output caused by the LVAD, and
reduced caloric consumption due to the mass effect of the device compressing the gastric antrum with subsequent reduction in oral intake.