Morbid obesity remains a strong risk factor limiting cardiac transplantation. Furthermore, numerous cardiac transplant databases have demonstrated that morbidly obese transplant recipients have nearly twice the 5-year mortality of normal-weight or overweight recipients. Hence, many morbidly obese transplant patients require ventricular assist devices to bridge them until they have lost sufficient weight to be considered for cardiac transplantation. Unfortunately, obtaining suitable weight loss via dietary or exercise regimens is limited by the cardiac limitations of the patients and has been shown to be of limited success. 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
We report on our experience of 2 morbidly obese (BMI 46.6, BMI 43.7) patients with severe non-ischemic cardiomyopathy who underwent a Ventricular Assist Device and Adjustable Gastric Band (VAD-BAND) placement for treatment of morbid obesity and potential future cardiac transplantation.
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.
Considering that the VAD generator is placed into the abdominal cavity, we demonstrate that concurrent placement of an adjustable gastric band is a safe, viable and effective option for the morbidly obese patient with end-stage heart disease. Although, our follow-up is short term, we believe that the VAD-BAND represents a promising advancement in both managing this patient population and fostering the potential for future cardiac transplantation for an otherwise terminal condition.
Program Number: P027