Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.
JACC Heart Fail. 2024 Oct;12(10):1661-1676. doi: 10.1016/j.jchf.2024.04.006. Epub 2024 Jun 19.
For adults with advanced heart failure, class II/III obesity (body mass index ≥35 kg/m) represents major challenges, and it is even considered a contraindication for heart transplantation (HT) at many centers. This has led to growing interest in preventing and treating obesity to help patients with advanced heart failure become HT candidates. Among all weight-loss strategies, bariatric surgery (BSx) has the greatest weight loss efficacy and has shown value in enabling select patients with left ventricular assist devices (LVADs) and obesity to lose sufficient weight to access HT. Nevertheless, both BSx and antiobesity medications warrant caution in the LVAD population. In this review, the authors describe and interpret the available published reports on the impact of obesity and weight-loss strategies for patients with LVADs from general and HT candidacy standpoints. The authors also provide an overview of the journey of LVAD recipients who undergo BSx and review major aspects of perioperative protocols.
对于患有晚期心力衰竭的成年人来说，II/III 类肥胖（身体质量指数≥35kg/m²）是一个主要的挑战，在许多中心，它甚至被认为是心脏移植（HT）的禁忌症。这导致人们越来越关注预防和治疗肥胖，以帮助患有晚期心力衰竭的患者成为 HT 候选者。在所有的减肥策略中，减重手术（BSx）的减肥效果最大，并已显示出在使患有左心室辅助装置（LVAD）和肥胖症的特定患者减轻足够体重以接受 HT 方面的价值。然而，BSx 和减肥药在 LVAD 人群中都需要谨慎使用。在这篇综述中，作者从一般和 HT 候选资格的角度描述和解释了现有的关于肥胖和减肥策略对 LVAD 患者的影响的已发表报告。作者还概述了接受 BSx 的 LVAD 受者的经历，并回顾了围手术期方案的主要方面。
