Frontiers in TransplantationThoracic transplantationLeft Ventricular Assist Device in Patients With Body Mass Index Greater Than 30 as Bridge to Weight Loss and Heart Transplant Candidacy

IntroductionIn obese patients with heart failure, weight reduction may be difficult due to physical restrictions, but may be necessary to achieve heart transplant candidacy. We report the outcomes of obese patients who underwent implantation of a left ventricular assist device (LVAD) using a pulsatile (HeartMate XVE [XVE]) or continuous flow (HeartMate II [HMII]) design and the effect on body mass index (BMI).MethodsOf 37 patients with BMI >30 kg/m2 who underwent LVAD implantation, 29 survived at least 30 days and were followed for weight change. In the 30-day survivors, end points of the study were continued LVAD support, heart transplant, or death. One patient underwent gastric bypass surgery and was excluded.ResultsIn the 28 patients who met inclusion criteria, BMI was 35.6 ± 4.4 kg/m2 at baseline, and at follow-up was 33.1 ± 5.5 kg/m2 (mean BMI change −2.5 kg/m2; P = .063), with a mean follow-up time of 301.6 ± 255.5 days. The XVE group showed a significant BMI reduction of 3.9 kg/m2 (P = .016 vs baseline); however, the HMII group showed 0.1 kg/m2 increase in BMI. BMI <30 kg/m2 at follow-up was achieved in 6 patients (21%), 5 of 19 (26%) in XVE group, and 1 of 9 (11%) in HMII group. In the 14 patients (12 XVE, 2 HMII) or 50% who received a heart transplant, the mean decrease in BMI was 4.6 kg/m2 (P = .003).ConclusionsLVAD placement in patients with BMI >30 kg/m2 provided significant weight loss in the pulsatile XVE group, but not in recipients of the continuous flow HMII. In patients successfully bridged to a heart transplant after LVAD insertion, mean reduction in BMI was 4.6 kg/m2 (P = .003). LVAD implantation provides a period of hemodynamic support for obese patients with advanced heart failure, during which time opportunity may be available for weight loss. Pulsatile devices appear to be associated with greater weight loss than nonpulsatile continuous flow devices. Additional therapies may be necessary to achieve significant weight loss in recipients of the continuous flow LVAD.