Morbidly obese patients with advanced heart failure rarely lose enough weight to qualify for heart transplantation, making ventricular assist devices destination therapy for many of them, researchers said.
Left ventricular assist devices (LVADs) provided adequate circulatory support as obese patients tried to qualify for heart transplants. The patients had a mean body mass index (BMI) of 39, which fell below that value in only a few cases during a year of follow-up, Dr. Jerry Estep reported here at the Heart Failure Society of America meeting.
Among patients who survived to one year, the mean BMI exceeded the baseline value.
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"Providing obese patients with [circulatory] support did not lead to weight loss," Estep, who practices at the Methodist Hospital in Houston told MedPage Today. "It's pretty obvious that long-term strategies for weight loss are needed to help obese patients with advanced heart failure lose weight and qualify for transplants."
Obesity increases the risk of heart failure and leads to worse outcomes after heart transplantation. As a result, many transplant centers have established a BMI cutoff of 35, said Estep. Patients whose BMI exceeds that level must lose sufficient weight to make the cutoff, even if they otherwise would qualify for transplantation.
Obese heart failure patients often receive LVADs during the period when they try to lose weight, but their impact on weight loss had not been studied extensively, and Estep and colleagues sought to fill some of the data gap.
Their review showed that 13 of 108 LVAD implantations over a six-year period involved morbidly obese patients (BMI =35). Of those 13 -- whose BMI averaged 38.8 -- eight received devices that provided continuous support and five got devices that provided pulsatile support. All 13 had New York Heart Association (NYHA) class IV heart failure at implantation.
The LVADs achieved the desired circulatory support, as the patients' mean functional class improved to NYHA class II at six months.
Mean BMI declined slightly during the first month after LVAD implantation but increased thereafter.
Subsequently, three patients underwent heart transplants after six months of LVAD support. They had BMI values of 37.6, 32.1, and 35.4 at transplantation.
Seven patients remained alive on LVAD support, and the remaining three patients died while awaiting transplantation.
"Morbidly obese patients can be adequately supported by LVADs, but a more specific weight-loss strategy is needed to help more patients lose enough weight to qualify for transplantation," said Estep.
A proposal has been developed to evaluate the coupling of LVAD placement with gastric bypass surgery as a means to increase the proportion of patients with advanced heart failure who can qualify for heart transplants, he added.