Combined Ventricular Assist Device Placement With Adjustable Gastric Band (VAD-BAND): A Promising New Technique for Morbidly Obese Patients Awaiting Potential Cardiac Transplantation

Abstract

Background: Morbid obesity remains a potential relative contraindication for cardiac transplantation. Hence, a select population of morbidly obese patients with end-stage heart failure may require a ventricular assist device (VAD) as a bridge to transplantation to afford them time to lose sufficient weight and thus decrease there mortality rate after transplantation. Unfortunately, obtaining suitable weight loss via dietary or exercise regimens is limited by the cardiac limitations of the patients. We report on a new procedure of combining ventricular assist device placement with adjustable gastric band (VAD-BAND) placement to facilitate sufficient weight loss for cardiac transplantation.

Methods: We report on our experience of 2 morbidly obese (BMI 46.6, BMI 43.7) patients with severe non-ischemic cardiomyopathy who underwent a VAD-BAND placement for treatment of morbid obesity and potential future cardiac transplantation.

Results: Patient 1 was a 24-year-old male with a body mass index (BMI) of 46.6 admitted in cardiogenic shock with severe non-ischemic cardiomyopathy (New York Functional Class IV, Left Ventricular Ejection Fraction 15.3%) who underwent the VAD-BAND procedure. At 11 months outpatient follow-up the patient had clinically improved with a BMI of 34.2. Patient 2 was a 36-year-old male with a body mass index of 43.7 admitted in cardiogenic shock with severe non-ischemic cardiomyopathy (New York Functional Class IV, Left Ventricular Ejection Fraction 17.1%) who underwent placement of a VAD-BAND. At 4 months post-operation, the patient was stalwart clinically with a BMI of 34.8. Both patients are now under consideration for cardiac transplantation.

Conclusion: In conclusion, concurrent placement of a VAD-BAND is a safe and viable option for morbidly obese patients with end-stage heart disease. Further research is needed to define indications and future clinical practice.




doi:10.4021/jocmr814w