title: Left ventricular assist device as 'bridge to weight loss' prior to transplantation in obese patients with advanced heart failure.
abstract: BACKGROUND
  Obesity is a risk factor for heart failure (HF) and associated with poor outcomes after cardiac transplantation. We assessed change in total body weight, morbidity and mortality in obese heart failure patients after implantation of a left ventricular assist device (LVAD) compared to medical management.
  
  
  METHODS
  Nineteen patients (9 females, age 51.3 ± 10 years) with a body mass index (BMI) ≥ 30.0 kg/m² and advanced HF (NYHA class III-IV, stage D) were evaluated. Thirteen (group 1) received insertion of a LVAD as bridge to transplantation. The remaining patients (group 2) were medically managed. All were advised on lifestyle modification.
  
  
  RESULTS
  At baseline, group 1 (49.1 ± 10.7 years) had a total body weight (BW) of 246.6 ± 34.9 pounds (mean ± SD) and a BMI of 36.1 ± 4 kg/m². Group 2 (56 ± 6.7 yrs) had a BW of 238.8 ± 73.6 pounds and a BMI of 39.1 ± 9.3 kg/m2 (n.s. compared to group 1). All patients were alive at 12 months. At 6 months, BW in group 1 was reduced to 216.3 ± 20.8 pounds, and BMI to 31.8 ± 3.3 kg/m² (p < 0.05). At 6 months, BW in group 2 was 238.2 ± 84.6 pounds, and BMI was 39.1 ± 11.6 kg/m² (n.s. vs. baseline, p < 0.05 compared to group 1). The decrease in BW in group 1 was 12.3 ± 12% (30.3 ± 28.5 pounds). There was no change in BW in group 2 (0.3 ± 8.7%, 0.6 ± 21 pounds, p < 0.05 vs. group 1). At 12 months, 7 patients in group 1 (54%) underwent cardiac transplantation.
  
  
  CONCLUSIONS
  LVAD insertion resulted in weight loss in obese patients not considered for heart transplantation compared to medically managed patients.
authors: Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors: Pavittarpaul
authors: P
authors: Dhesi
authors: Sinan A
authors: SA
authors: Simsir
authors: Daniel
authors: D
authors: Daneshvar
authors: Asim
authors: A
authors: Rafique
authors: Anita
authors: A
authors: Phan
authors: Ernst R
authors: ER
authors: Schwarz
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002302:Cardiac Output; D000075202:Contraindications; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000473:pathology; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss